Neurodevelopmental disorders related to humans

About neurodevelopmental disorders

1. Neurodevelopmental Disorders Presented By: Group 2 ~AREEBA NADEEM, HIRA SIDDIQUE, MUNAZZA , BARIRA YAQUB , DANIA JAVED

2. Neurodevelopmental Disorder Neurodevelopmental disorders are disabilities associated primarily with the functioning of the neurological system and brain. NDs usually onset during stages of development which makes them most present in toddlers, children, and adolescents, but continue to persist into adulthood, or may go undiagnosed until one is an adult. 2

3. Causes and Symptoms Biological Environmental Epigenetics Causes Symptoms Memory Language Behavior  Motor skills  Learning Speech Social skills Emotions

4. Symptoms A child with ADHD might: Daydream a lot Forget or lose things a lot Squirm or fidget Talk too much Make careless mistakes or take unnecessary risks Hard time resisting temptation Trouble taking turns Difficulty getting along with others Unable to concentrate on tasks Excessive physical movement

5.   Diagnostic Criteria A A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

6. d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines). f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). i . Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

7. 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a. Often fidgets with or taps hands or feet or squirms in seat. b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place). c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.) d. Often unable to play or engage in leisure activities quietly. e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). f. Often talks excessively. g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation ).

8. B C D E h . Often has difficulty waiting his or her turn (e.g., while waiting in line). i . Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing). Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. 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). There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. 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).

9. Duration and Age Limit

10. Development and Course

11. Risk and Prognostic Factors

12. Functional Consequences Poor academic achievement and attainment Poor occupational rank and job performance Unemployment Risky sexual practices Early unwanted pregnancies Substance use Relationship difficulties Negative family interactions Marital problems Lower self-esteem Reduced quality of life. Major disorders

13. Case Study Jack is a 7-year-old male. He is Grade 1 student who lives in Toronto with his parents. There is an extended family history of Attention Deficit/Hyperactivity Disorder (ADHD), mental health concerns as well as academic excellence. Jack is an intelligent and caring young boy who presents with significant potential to excel academically. They also report that Jack gets upset when he does not receive recognition or feels that he has been ignored. His teacher notes that he sometimes acts 'socially immature', and that he often demonstrates attention-seeking behavior. Jack describes difficulties with focusing, and sitting still in class. He recognizes that he is able to 'hyper focus' on some activities of interest, however he often has difficulty sustaining his attention at school. His parents and teacher indicate that Jack is restless, and often requires reminders to help him stay on task. He is described as "constantly running around" and presenting with difficulties listening and following instructions. Jack's teacher indicates that he often blurts out answers and interrupts other students in the classroom. Jack recognizes this tendency in himself, but says that he 'can't stop' in spite of his best intentions. Jack has always had challenges falling asleep, and sometimes finds that he wakes up in the middle of the night. When he wakes up he finds that he has a difficult time getting back to sleep. His mother reports difficulties at home with following routines and remembering instructions and cannot organize things. His parents describe emotional reactivity as well as confrontational behaviors demonstrated both at home and at school. His teacher notes that Jack is very defiant towards listening to instructions, but generally interacts well with his peers. He is easily frustrated and emotionally impulsive - Jack has had several incidents of hitting, crying outbursts, and inappropriate behavior. Behavioral concerns with aggression, lying, arguments, and disruptive behavior were noted in pre-school program at age 4.

14. Learning Disabilities Specific learning disability is a disorder in one or more of the central nervous system processes involved in perceiving, understanding, and/or using concepts through verbal (spoken or written) language or nonverbal means. Learning disability' is an umbrella term covering many different intellectual disabilities. It means that a person's capacity to learn is affected and that they may not learn things as quickly as other people. Sometimes a learning disability is called a learning difficulty, intellectual impairment or intellectual disability.

15. Symptoms Poor memory Difficulty focusing Short attention span Difficulty with reading or writing Inability to distinguish between sounds, letters, or numbers Difficulty sounding out words

16. Diagnostic Criteria A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: 1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants).

17. 4.Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization: written expression of ideas lacks clarity). 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers Instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).

18. B. The affected academic skills are substantially and quantifiably below those expected for the individual's chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardised achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardised assessment. C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the Individual's limited capacities ( eg , as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads) D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction. Note: The four diagnostic criteria are to be met based on a clinical synthesis of the individual's history (developmental, medical, family, educational)school reports, and psychoeducational assessment.

19. Development and Course Learning disabilities can emerge in early childhood but often go unnoticed until school age. They can persist throughout life, ranging from overlapping challenges to isolated issues. Those with an average mental age of 9-12 may face hurdles in learning and complex tasks, but specialized interventions and early assistance can help. Despite challenges, many individuals with specific learning disorders can lead independent lives. Notably, this disorder is more prevalent in males than females.

20. Risk and Prognostic Factors Environmental -Prematurity or very low birth weight, prenatal exposure to nicotine, perinatal injury Genetic and physiological - aggregate in families, relative risk of specific learning disorder in reading or mathematics is substantially higher (e.g., 4-8 times and 5-10 times higher, respectively) in first-degree relatives of individuals with these learning difficulties compared with those without them. Frequently found in association with a variety of general medical conditions (e.g., lead poisoning, fetal alcohol syndrome, or fragile X syndrome).

21. Functional Consequences Specific learning disorder can lead to various negative consequences throughout life, such as lower academic achievement, increased high school dropout rates, decreased postsecondary education rates, elevated psychological distress, and overall poorer mental health. Additionally, there's a higher likelihood of unemployment, underemployment, and lower incomes. School dropout and concurrent depressive symptoms heighten the risk of poor mental health outcomes, including suicidal thoughts or behaviour. Conversely, strong social and emotional support can predict better mental health outcomes.

22. Case study Harshita faced learning challenges due to an executive functioning learning disability in her previous school in Ghanahati . This condition makes it difficult for her to retain information and write properly despite having a decent IQ. She was referred to the special school UDAAN in 2013, where she receives tailored support. Teachers at Udaan focus on her individual pace, repeat concepts, and provide positive reinforcement, leading to progress in writing, reading, and basic math. Harshita responds well to love and patience due to her sensitivity. Her parents actively support her education and aim for her independence through vocational training, ensuring she can sustain herself in the future.

23. Motor Disorders

24. Motor Disorders

25. Developmental Coordination Disorder Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia, or simply dyspraxia, is a chronic neurological disorder beginning in childhood. It is also known to affect planning of movements and coordination as a result of brain messages not being accurately transmitted to the body. Impairments in skilled motor movements per a child’s chronological age interfere with activities of daily living.

26. Symptoms Difficulty with walking up and down stairs. Difficulty with balance — they may bump into objects, fall frequently or seem clumsy. Difficulty with sports and activities, such as riding a bike; jumping; and catching, throwing or kicking a ball. They may avoid participating in activities because of their lack of coordination. Difficulty with writing, drawing/coloring and using scissors compared to other children their age. Difficulty getting dressed, fastening buttons, brushing their teeth and tying shoelaces. Restlessness — they may swing or move their arms and legs frequently.

27. Diagnostic Criteria A . The acquisition and execution of coordinated motor skills is substantially below that expected given the individual's chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports). B. The motor skills deficit in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g., self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play. C. Onset of symptoms is in the early developmental period. D. The motor skills deficits are not better explained by intellectual disability (intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder).

28. Duration and Age Limit Early Developmental Period At least to 1 year follow-up

29. Development and Course In Early Childhood In Middle Childhood In Early Adulthood

30. Risk and Prognostic Factors

31. Functional Consequences of Developmental Coordination Disorder Reduced participation in team play and sports Poor self-esteem and sense of self-worth Emotional or behavioral problems Impaired academic achievement Poor physical fitness Reduced physical activity and obesity Poor health Related quality of life

32. Case Study Jack, a 12-year-old student in his second term of secondary school, is facing challenges in coping with his academic demands despite his above-average intelligence. His difficulties primarily stem from coordination issues, particularly affecting his handwriting, which persists even when using a laptop. Living with his younger sister and two parents, Jack's early development was relatively typical until concerns arose at the age of 6 during his first year of primary school. At that time, Jack's parents and teachers observed struggles in his physical skills development compared to his peers. His inability to button his coat, difficulties controlling a pencil, challenges in riding a bike (even with stabilizers), and reluctance to engage in physical activities like playing on the climbing frame raised concerns.

33. Additionally, Jack displayed signs of being easily distracted in class, struggled to complete tasks, and exhibited temper tantrums at home. The GP's physical examination did not identify any clear explanation for his movement skill challenges, and there were no definitive signs of disorders such as cerebral palsy or muscular dystrophy. Further investigation led Jack to the local Child Development Centre, where an educational psychologist and an occupational therapist (OT) assessed him. The Movement ABC test confirmed significant movement difficulties, placing him below the 5th percentile for his age. Despite a full-scale IQ of 125 from the WISC-R, teacher and parent questionnaires revealed attention issues, low self-esteem, and concerns about his lack of friends. The collective information from Jack's parents, teachers, GP, OT, and educational psychologist led to the consensus that Jack met the criteria for Developmental Coordination Disorder (DCD) as outlined in the DSM-IV of the American Psychiatric Association (APA, 2000).

34. Video

35. Stereotypic Movement Disorder ( Repetitive & purposeless movements)

36. Symptoms Body rocking Arm waving Hand flapping Finger wiggling Hair twisting Head nodding Head banging Thumb sucking Nail biting Hitting oneself Mouthing objects Biting oneself

37. Primary Motor Stereotypies Seen in typically developing children Viewed as a movement disorder due to the absence of other neurological symptoms Disappear with the passage of time Secondary Motor Stereotypies Seen in both children and adults Associated with some other developmental disorder (autism, intellectual and developmental issues) Precede with passage of time Causes

38. Diagnostic Criteria A. Repetitive, seemingly driven, and apparently purposeless motor behavior (e.g., hand shaking or waving, body rocking, head banging, self-biting, hitting own body). B. The repetitive motor behavior interferes with social, academic, or other activities and may result in self-injury. C. Onset is in the early developmental period. D . The repetitive motor behavior is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder (e.g., trichotillomania [hair-pulling disorder], obsessive-compulsive disorder).

39. Duration and Age Limit

40. Development and Course

41. Risk and Prognostic Factors

42. Functional Consequences Self-injury or bodily harm Interfere normal functioning of life Impaired cognitive and social functioning Sometimes may lead to other medical issues

43. Case Study A 49-year-old man presented with 27-year history of self-injurious behavior. His hospital admission followed a severe episode of head-banging resulting in brief weakness, numbness, and tingling in all extremities. He hit his head against walls, furniture, or other hard surfaces. The behavior occurred daily, was repetitive and stereotyped, and was facilitated by anxiety, fatigue, boredom, and isolation. Sudden loud noises, such as slamming doors, also triggered head-banging. His self-injury was not preceded by rising tension or anxiety, but he did experience some sense of pleasure with head-banging. On past medical history, the patient had numerous hospitalizations for his self-injurious behavior and was treated with haloperidol, risperidone, thioridazine, chlorpromazine, high-dose fluoxetine, and multiple attempts at physical restraint, none of which were effective. The patient’s prior injuries from head-banging included nose fractures, a ruptured left eye globe, and numerous soft tissue traumas. This patient exhibits the condition, stereotypic movement disorders (SMD) with self-injurious behavior in intellectually normal adults. This patient was able to temporarily suppress the movements, but he did not have a mounting tension preceding the event or a sense of relief following the event as seen in tic disorders and obsessive-compulsive disorder (OCD). Moreover, he reported a self-stimulatory or pleasurable component of these behaviors, as often seen with SMD.

44. Video

45. Tic Disorder

46. Tic Disorder Tic disorders are a group of conditions characterized by the Presence of tics, which are sudden and repetitive movements or sounds that individuals cannot control. Tics can manifest Motor tics Vocal tics

47. Classification Of Tic Disorder DSM-5-TR has classified the tic disorder into three groups;

48. Tourette’s Disorder Diagnostic Criteria A Both multiple motor and one or more vocal tics have been present at sometime during illness, although not necessarily concurrently B The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. C Onset is before age 18 years. D The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis)

49. Persistent (Chronic) Motor or Vocal Tic Disorder Diagnostic Criteria A Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal. B The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. C Onset is before age 18 years D The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis). E Criteria have never been met for Tourette’s disorder.

50. Diagnostic Criteria of Provisional Tic Disorder Diagnostic Criteria A Single and multiple motor and/or vocal tics. B The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. C Onset is before age 18 years. D The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis) E Criteria have never been met for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder.

51. Causes

52. Motor tics Blinking or rapid eye movements Jerking or shrugging of the head Facial grimacing or twitching Shoulder rolling or shrugging Hand or arm movements, such as touching or tapping Jumping or hopping Complex movements, like twirling or bending

53. Vocal tics Throat clearing or coughing Grunting or snorting Clicking sounds or sniffing Repeating words or phrases (echolalia) Shouting or yelling Uttering swear words or offensive language (in some cases )

54. Note: It's important to note that tics can vary in severity and frequency. They may worsen in certain situations, such as during periods of stress, excitement, or tiredness. Tics can also change over time and may improve during adolescence or adulthood.

55. Developmental Course

56. Risk and Prognostic Factors

57. Functional Consequences Impact on daily functioning Impaired academic performance Social difficulties Emotional well-being Co-occurring conditions Occupational limitations

58. Case study JB is age 35, right-handed, with a history of generalized anxiety disorder, and presenting to clinic for evaluation and management of unusual movements that began in adolescence. JB also makes brief vocalizations including throat clearing and grunting. The movements and vocalizations have become more frequent and disabling, evolving from rare, mild, and manageable to preventing use of a computer or holding an effective business meeting. There is an anticipatory sensation and urge to perform the movements beforehand followed by relief after completing the movements. JB can suppress these tics temporarily, but after several seconds there is a building urge to perform them. These unusual movements began occurring when JB was age 6 as sudden, brief, jerking movements of the neck and brief shoulder shrugs. In adolescence, JB was diagnosed with a tic disorder by a neurologist and told that the tics would resolve on their own with time; no therapeutics were tried. Family history is notable for obsessive-compulsive disorder (OCD)-like behaviors in JB’s father and anxiety in JB’s brother. JB’s generalized anxiety began in adolescence and is currently poorly controlled owing to life stressors. JB takes 0.5 mg clonazepam tablets, as needed, up to 3 times daily for anxiety; rarely drinks alcohol; and reports being a nonsmoker who uses no other drugs.

59. Thankyou!