Module 8 Neurodevelopmental Disorder

- ADHD ( attention- deficit/hyperactivity disorder)

- Autism Spectrum Disorders
- Intellectual Disability

- Neurodevelopmental disorders typically occur during the developmental

period, which begins in uterus and extends through early childhood.
- It is a broad category of conditions that affect neurological development,
typically starting in early childhood. These disorders involve impairments in
the growth and development of the nervous system, which can result in
difficulties in various aspects of functioning, including cognition, learning,
communication, social interaction, and motor skills.
- This category includes a wide range of conditions, such as Attention-
Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorders
(ASD), Intellectual Disability, Specific Learning Disorders, and
Communication Disorders.

Intellectual Developmental Disorder

(Intellectual Disability)
- Deficits in general mental abilities, such as reasoning, problem solving,
judgment, academic learning, and learning
- The deficits result in impairments of adaptive functioning in one or more
aspects of daily life, including social participation, academic or occupational
functioning, and personal independence.
- When a person fails to meet expected developmental milestones, they are
diagnosed with global developmental delay. The diagnosis is used for
individuals younger than 5 years who are unable to undergo systematic
assessments of intellectual disability , and thus the clinical severity level
cannot be reliably assessed as initial diagnoses of intellectual disability most
frequently occur at ages 5 to 6

Diagnostic criteria for Intellectual developmental Disorder

Intellectual developmental disorder (intellectual disability) is a disorder with onset
during the developmental period that includes both intellectual and adaptive
functioning deficits in conceptual, social, and practical domains. The following
three criteria must be met:
a. Deficits in intellectual functions, such as reasoning , problem solving,
planning, abstract thinking, judgment, academic learning, and learning from
experience, confirmed by both clinical assessment and individualized,
standardized intelligence testing.
b. Deficits in adaptive functioning that result in failure to meet developmental
and sociocultural standards for personal independence and social
responsibility. Without ongoing support, the adaptive deficits limit
functioning in one or more activities of daily life, such as communication,
social participation, and independent living, across multiple environments,
such as home, school, work, and community.
c. Onset of intellectual and adaptive deficits during the developmental period.

Note: The term intellectual developmental disorder is used to

clarify its relationship with the WHO ICD-11 classification system,
which uses the term Disorders of Intellectual Development. The
equivalent term intellectual disability is placed in parentheses for
continued use. The medical and research literature use both
terms, while intellectual disability is the term in common use by
educational and other professions, advocacy groups, and the lay
public. In the United States, Public Law 111-256 (Rosa’s Law)
changed all references to “mental retardation” in federal laws to
“intellectual disability.”

Diagnostic Features
- The diagnosis of intellectual developmental disorder is determined through
clinical assessment, standardized tests of intellectual functions,
neuropsychological tests, and adaptive functioning.
- Co-occurring disorders that affect communication, language, and/or motor
or sensory function may affect test scores.
- IQ test results are estimates of intellectual ability but may not be enough to
judge real-life thinking or practical activities. For eg., a person with an IQ
score slightly higher than 65-75 may still have adaptive behavior problems
 in social judgement, indicating that their actual functioning is clinically
similar to those with lower scores. Clinical judgement is crucial when
evaluating IQ test results.
- Deficits in adaptive functioning refer to how well a person meets
community standards of personal independence and social
responsibility in comparison to others of similar age and sociocultural
background. It involves adaptive functioning in three domains:
conceptual, social, and practical.
➔ The conceptual (academic) domain - competence in memory,
language, reading, writing, knowledge, and judgment.
➔ The social domain - awareness of others’ thoughts, feelings, and
experiences; empathy; communication; friendship abilities; and
social judgment.
➔ The practical domain- learning and self- management across life
settings, including personal care, job responsibilities, money
management, and school and work task organization, among
others.
- Criterion B is met when at least one domain of adaptive functioning—
conceptual, social, or practical—is sufficiently impaired that ongoing
support is needed in order for the person to perform adequately across
multiple environments, such as home, school, work, and community.
- Criterion C, onset during the developmental period, refers to recognition
that intellectual and adaptive deficits are present during childhood or adolescence.

Level of Intellectual Disability ( for understanding purpose)

- Normally, people receive a score somewhere between 70 and 130
- MILD INTELLECTUAL DISABILITY. An adult with a mild
disability who has a mental age of 10 (meaning his or her cognitive
test performance is at the level of the average 10-year-old) may not
have equivalent information-processing capacity or speed.

- MODERATE INTELLECTUAL DISABILITY: Intellectual levels

similar to those of average 4- to 7-year-old children; their rate of
 learning is slow, and their level of conceptualizing is extremely
limited

- SEVERE INTELLECTUAL DISABILITY: People commonly suffer

from impaired speech development, sensory defects, and motor
handicaps. They may develop basic personal hygiene and self-help
abilities, which reduces their reliance.

- PROFOUND INTELLECTUAL DISABILITY: Inability to master

simple tasks frequently results in slowed growth, mutism, deafness,
and other physical defects. They require continual custodial care, are
in poor health, have low illness resistance, and have a short life
expectancy due to their lack of disease resistance.

Prevalence -
The global prevalence varies by country and level of development, with
approximately 16 per 1,000 in middle-income countries and 9 per 1,000 in high-
income countries. The prevalence also varies by age, being higher in youth than in
adults. Males are more likely than females to be diagnosed with intellectual
disability.

Development and Course-

➔ Intellectual developmental disorder is typically non-progressive but can
experience periods of worsening and gradual decline in intellectual function.
 ➔ In some cases, this decline may overlap with neurocognitive disorder,
leading to both diagnoses. ( eg- persons with Down syndrome being at high
risk for developing neurocognitive disorder due to Alzheimer’s disease in
adulthood)
➔ ID can be abruptly onset following illnesses like meningitis or head trauma
during the developmental period. In severe cases, such as traumatic brain
injury, both the diagnoses of intellectual developmental disorder and
neurocognitive disorder may be made.
➔ Intellectual developmental disorder is a lifelong condition influenced by
underlying medical or genetic conditions, brain dysfunction, and co-
occurring conditions. (e.g., hearing or visual impairments,epilepsy).
➔ Severe form of ID may be identifiable within the first two years of life,
while mild levels may not be until school age. Some children younger than
5 years that show symptoms that will eventually meet criteria for intellectual
developmental disorder have impairments may meet criteria for global
developmental delay.

Comorbidity-
Co-occurring conditions are frequent in intellectual disability (e.g., mental
disorders, cerebral palsy, epilepsy, and other medical conditions) and four times
higher.
The most common co-occurring mental disorders which may occur throughout the
range of severity of intellectual disability are
- ADHD ; autism spectrum disorder
- depressive and bipolar disorders;
- anxiety disorders;
- major neurocognitive disorder.
- Individuals with intellectual disabilities, particularly those with more severe
disabilities, may also exhibit aggression and disruptive behaviors, including
harm to others or property destruction.
- Intellectual developmental disorders have more health problems, including
obesity, than the general population.
Etiology
While many reasons for intellectual disability remain unknown, the etiology can be
divided into two categories: genetic defects and environmental exposure.
- Genetic-chromosomal Factors: A genetic abnormality can be a single
gene mutation, copy number variation, or chromosomal abnormality that
results in an inborn metabolic ( bna and tutna ) ( eg - sickle cell anemia )
mistake. The most common chromosomal cause is Down syndrome, and the
most common genetic cause is Fragile X syndrome.

- INFECTIONS AND TOXIC AGENTS: Intellectual disability can also

result of infections, such as genital herpes. If a pregnant woman is exposed
to a number of toxic agents, such as carbon monoxide and lead, during fetal
development or after birth, or if she takes certain drugs or alcohol, it may
result in brain damage.

- TRAUMA (PHYSICAL INJURY): Physical injury at birth can result in

an intellectual disability. Difficulties in labor due to malposition of the fetus
may damage the infant’s brain. Bleeding within the brain and a lack of
sufficient oxygen can cause birth trauma that may damage the brain.

- IONIZING RADIATION Radiation may act directly on the fertilized

ovum or may produce gene mutations in the sex cells of either or both
parents, which may lead to intellectual disability among offspring.

- MEDICAL CONDITIONS Having certain medical conditions while

pregnant can cause developmental differences in a fetus. Those can later
result in intellectual disability. Examples include hormonal conditions like
hypothyroidism.( T3 less TSH MORE )

- ENVIRONMENTAL AND OTHER BIOLOGICAL FACTORS:

Maternal exposure to toxins/infectious agents, uncontrolled maternal
medical problems, delivery issues, and post-natal trauma are all examples of
environmental exposure.
 - The most commonly known environmental cause of intellectual disability is
fetal alcohol syndrome. It occurs when alcohol is consumed during
pregnancy.
- Malnutrition may affect mental development more indirectly by altering a
child’s responsiveness, curiosity, and motivation to learn, which would in
turn lead to intellectual disability.

Differential Diagnosis-
- Major and Mild Neurocognitive Disorders: Intellectual disability is
categorized as a neurodevelopmental disorder and is distinct from
neurocognitive disorders, which are characterized by a loss of cognitive
functioning. Major neurocognitive disorder may co-occur with intellectual
disability (e.g., an individual with Down syndrome who develops
Alzheimer's disease). The difference is whether someone has lost a prior
level of functioning. In this case, it is called a neurocognitive disorder
(formerly dementia). If someone never developed this level of functioning in
the first place, it is called an intellectual disability. It is possible to have both
diagnoses.

- Autism Spectrum Disorder: Intellectual disability is common among

individuals with autism spectrum disorder. Appropriate assessment of
intellectual functioning in autism spectrum disorder is essential because IQ
scores in autism spectrum disorder may be unstable, particularly in early
childhood.

- Communication disorders and specific learning disorders:

neurodevelopmental disorders are specific to communication and learning
without intellectual or adaptive deficits. They may co-occur with intellectual
developmental disorders, and diagnoses are made if full criteria for these
disorders are met.
Treatment for Intellectual Disability
Management of intellectual development disorder (intellectual disability) must
begin promptly with the goals to prevent further worsening, minimize the
symptoms of the development disorder, and improve the quality of everyday life.

● Education support and interventions ( interrupt krna) : Educational

support is a crucial component of intellectual development disorder
management. Upon diagnosis of intellectual development disorder in
children, healthcare providers must contact the school promptly to set up
special education arrangements.

● What special education entails may vary slightly among schools, but it
typically aids comprehensively with providing academic modifications as
well as transition planning from childhood to adulthood with a focus on
promoting self-sufficiency.

● If an individual with an intellectual development disorder requires assistance

beyond what is available at school, the family can meet the need at home
through family education or other outside resources.

● For example, a disabled student who needs extra attention with social skills
may be referred to participate in the Special Olympics programs that have
been shown to improve social competence in intellectual development
disorder subjects.

● Behavioral support and interventions. Behavioral therapy aims to

encourage positive behaviors while discouraging undesirable behaviors.
Providing positive reinforcement and benign punishments (e.g., time-outs) is
an effective method of behavioral training.

● Other supplemental methods may include avoiding triggers of negative

demeanor , shunning misconduct, and redirecting to prevent or curtail any
troublesome behavior.

● Cognitive therapy is another mode of behavioral training that has been

effective for eligible intellectual development disorder patients. Cognitive
therapy has its basis on a principle that one’s behavior, emotions, and
 cognitions are connected, and it aims to correct one’s negative behaviors by
identifying and adjusting negative thoughts and emotional stress.

● Vocational training: Vocational training helps teenagers and young adults

to obtain the necessary skills to enter the labor market. In vocational
training, patients carry out pre-scheduled activities under the supervision of
a multi-disciplinary team consisting of a social worker, occupational
therapist, teacher, counselor, and psychologist. Patients learn to keep
themselves clean, wear appropriate clothes, and carry out their
responsibilities.

● Family education. The first part of this education is assisting the family
members in understanding intellectual development disorder: definition,
management, and prognosis. Then, healthcare providers can help the family
through placement decisions, refer them to appropriate services and
equipment, and provide caregiver training. In addition to preparing the
family for the patient, physicians must recognize that family members also
often bear a significant amount of stress as well. The medical team must
support the whole family through psychosocial problems such as the need
for respect, feeling helpless, depression, and anxiety.

Case Study
Sarah, a 20-year-old college student, has had academic and social difficulties since
childhood. Despite her best efforts, she consistently falls behind her peers in a
variety of subjects, finding it difficult to grasp complex concepts. Her professors
and classmates notice her difficulties, but there's a lack of understanding regarding
the underlying issue.
Sarah's academic performance has been concerning. She frequently requires
additional assistance and time to complete the assignment. Her classmates notice
her difficulties in social situations, where she may struggle to understand jokes or
engage in casual conversations. Sarah is evaluated thoroughly after consulting with
a healthcare professional specializing in intellectual disabilities. Sarah has an
intellectual disability, according to the results. Her reasoning, problem-solving, and
learning abilities are significantly below average. Adaptive behavior is also
affected, including daily living skills, communication, and social interaction.
Sarah's healthcare team, which includes psychologists, educators, and therapists,
works together to develop a personalized treatment plan. The plan focuses on
enhancing her strengths, addressing specific challenges, and promoting
independence.
With ongoing support and intervention, Sarah begins to show improvements in her
academic performance and social interactions. While she may face challenges
throughout her life, the goal is to empower her to lead a fulfilling and independent
life.