Chapter 1

Chapter 1: Systemic Levels in Neurodevelopmental Disorders  Introduction o Neurodevelopmental disorders—broadly defined as disorders that manifest or appear in the developmental period  Can be defined as a series of complex traits that emerge as a result of genetic determinants interacting with various poorly understood environmental components resulting in a diverse clinical presentation o Associated with infancy, childhood, and adolescence o These disorders rarely experience a remission or relapse and are considered to be a stable set of symptoms over time  DSM-5 and Family Systems o Because neurodevelopment disorders are commonly diagnosed in childhood, it is the parent or caregiver of the individual with a neurodevelopmental disorder who seeks assistance through a physician, psychologist, counselor, social worker, or teacher o Parents are often first to notice differences in their children and are asked to regularly monitor their development through scheduled pediatric well-child care visits at critical periods in growth and development o The American Academy of Pediatrics’ recommendation that all pediatricians screen for developmental delays serves to increase awareness about developmental issues and preventative measures  Reality is few pediatricians use standardized assessments when assessing for developmental delays o Neurodevelopmental Disorders as Significant Focus of Attention  Systemic clinicians are now regularly asked questions about the assessment, diagnosis, and treatment of neurodevelopmental disorders, whereas, in the past, neurodevelopmental disorders were treated primarily by medical professionals in neurology or pediatrics o The Role of Neurodevelopment in Families  Parents are impacted by the increased attention on neurodevelopment  Emerging research continues to show that neurodevelopment is the interaction between genetic inheritance and the environment  Ultimately, genes and the environment are refereed by nongenetic influences to make up the brain from conception to adulthood  The biological origination of specific learning disorders is the interaction of genetic, epigenetic and environmental factors  Families may be curious about how to promote healthy neurodevelopment  To understand the root cause of the neurodevelopmental disorder is a key element to understanding as a whole o Neurodevelopmental Versus Neurocognitive  Neurodevelopmental disorders can be mistaken for neurocognitive disorders  The important distinction between neurodevelopmental and neurocognitive disorders is that neurodevelopmental disorders emerge in the developmental

period of life versus neurocognitive disorders which are acquired during the life span  Age of onset is important o Neurodevelopmental Disorders in the DSM-5  Categories include intellectual disability, communication disorder, asd, adhd, specific learning disorder, and motor disorders  The term mental retardation has been replaced with intellectual disability  Comes as a result of use by persons in the medical community, counselors, educators, and advocacy groups  Relational And Cultural Features o Culture affects how people relate and cope with neurodevelopmental disorders, and defines neurodevelopmental disorders to such an extent that cultural differences among people act as barriers for the proper assessment and treatment of these disorders throughout the world  Makes family systems most adequate treatment option because, in family systems, the family’s views, goals, relationships, and value systems are the main point of interest for therapy o Studies have shown that there are different manifestations of neurodevelopmental disorders in different cultures, begging the question if some subscales should be modified or discarded to properly evaluate a more diverse group of people o Language Disorder (LD) and Culture  When assessing LD and other neurodevelopmental disorders in developing countries, it is noted that a lack of any formal education or lack of exposure to visual representations of objects makes applying standardized tests an unreliable way of diagnosing neurodevelopmental disorders  A non-English speaker or English as a second language speaker may have challenges that can be accounted for by regional, social, and/or cultural variations of language  Most of the LD standardized tests are made by and for white middle-class, English speaking people  Even if the tests are translated, elemental differences between English and other languages make English speaking people with LD manifest deficiencies in certain aspects of language where people who speak another language and also have LD do not manifest impediments  Dilectual differences are another boarder between countries that speak the same language (i.e., British English versus American English) o ASD and Culture  AQ is a widely used test to score the degree of autism in people divided into 5 subscales  Imagination  Attention to detail  Attention switching  Social skill  Communication

 There are typically subsequent visits to assess medical, developmental, behavioral, or neurological factors impacting functioning  All of the following might be included in the assessment process  Child and parent interviews  Biopsychosocial assessment with a complete family history  Genogram  Parent and teacher self-completed rating scales of child behavior  Self-reported information from parent or caregivers  Observation of child behavior at home, school, and in the office  Psychological tests  Medical record review  School record review  Intelligence testing and achievement testing  Pediatric examination for medical conditions  Neurodevelopmental screening  Vision, hearing, and speech and language assessments  Family Systems Interventions o Ultimately, the intervention approaches differ in the methods used to address goals o Interventions can range from behavioral therapies to social-emotional strategies to developmental techniques o The goals of the intervention program can differ from individual treatment of the person with a NDD to comprehensive interventions involving parents and caregivers with an interdisciplinary team to address a wide range of skills or behaviors o Comprehensive intervention programs work with parents and caregivers to develop effective strategies for the given client and provide feedback for the growth and development of treatment goals and objectives  Clinicians should be aware of the social contexts of home, school vocation, and community when choosing interventions  Clinicians should be aware that over time family interactions and relationships will change, and this the needs of the family for specific interventions will change over time o When a clinician is selecting an intervention, the clinician can match the intervention with the treatment goals and objectives for the family and their current functioning around the disorder o Intellectual Disability  Characteristically a deficit in general mental abilities  Families may notice minimal to slow motor skills, language skill, and self- help skill development in comparison to peers  There may be failure to develop intellectually or problems maintaining expectations in school  Parents may notice social challenges  Most commonly served via the education system with an Individualized Education Plan (IEP)  Individualized Family Service Plan

 Details the child’s specific needs and the services that will help the child thrive  Early interventions may be numerous and couple include SLP, OT, PT, family counseling, or nutritional services  Stress Intervention  Specifically, cognitive behavioral group interventions designed to reduce the stress of mothers show the strongest research evidence for success o Communication Disorders  A deficit in receiving, sending, processing, and/or comprehending concepts or verbal, nonverbal, and graphic symptoms  Specific disorders include LD, speech sound disorder, childhood-onset fluency disorder, social communication disorder, unspecified communication disorder  Parent-Mediated Interventions  Using the learned interventions for a session with SLP or other trained profession can increase learning outcomes for the child  Speech Therapy o ASD—Family-Oriented Interventions  Interventions range from behavioral interventions to social communication interventions  Clinicians are encouraged to do additional research on techniques and treatment approaches that might support the child and family with whom they are working  Pivotal Response Treatment (PRT)  Derived from ABA, PRT is play based and child initiated  PRT addresses what are called “pivotal” areas in development, such as motivation, response to various cues, self-management, and social interaction initiation  Parents can lead PRT  SCERTS Model  SCERTS—Social Communication, Emotional Regulation and Transactional Support o Involves using various interventions to achieve child-initiated communication and authentic progress, that is, the ability to learn and apply skills in a spontaneous functional way in a variety of settings  Early Start Denver Model (ESDM)  Designed to address ASD through child-led, play-based treatment that zones in on the development of social communication skills through counseling, peer interactions at school, and home-based psychoeducation  ESDM is rooted in deep parental involvement and shared engagement in activities o /Hyperactivity Disorder—Family-Oriented Interventions

ICF Syndrome ATR-X Syndrome Angelman Syndrome Other Single Genetic Lesion syndromes Biological Causes -Prenatal Disorders Arrested Hydrocephalus Biological Causes -Perinatal Disorders Prematurity Peripartum Ischemic Encephalopathy Fetal Distress Syndrome Biological Causes -Postnatal Disorders Anoxemia at birth Postnatal Infection Primary Neoplasm Illness or Disease -Psychosocial Emotional Trauma Neglect abuse Abuse/maltreatment Antenatal Maternal Stress Illness or Disease -Environmental Exposure to toxins known and unknown Alcohol, tobacco, drugs Mercury Lead Polychlorinated Biphenyls Dioxins Pesticides Ionizing Radiation Aluminum Acetaminophen In utero exposure to toxins known and unknown Poverty Family Life Illness or Disease -Emotional Lack of attachment Poor Family Dynamics Divorce and Remarriage Foster Care Neurodevelopmental Disorders Category/Disorder Subtype/Disorder Intellectual Disability  Intellectual Disability (Intellectual Development Disorder)

o Mild o Moderate o Severe o Profound  Global Developmental Delay  Unspecified Intellectual Disability (Intellectual Developmental Disorder) Communication Disorders  Language Disorder  Speech Sound Disorder  Childhood-Onset Fluency Disorder (Stuttering)  Social (Pragmatic) Communication Disorder  Unspecified Communication Disorder ASD  Specify if: associated with medical or genetic condition or environmental factor; associated with neurodevelopmental, mental, or behavioral disorder  Specify severity: amount of support required  Specify if: with or without intellectual impairment, with or without accompanying language impairment, with catatonia ADHD  Combined presentation  Predominantly inattentive presentation  Predominantly hyperactive/impulsive presentation o Specify: in partial remission o Specify severity: mild, moderate, severe  Other Specified ADHD disorder  Unspecified ADHD disorder Specific Learning Disorder  Specify if: o With impairment in reading o With impairment in written expression o With impairment in mathematics o Specify severity: mild, moderate, severe Motor Disorder  Developmental Coordination Disorder  Stereotypic Movement Disorder o Specify if: with SIB, without SIB o Specify if: associated with known medical or genetic condition, neurodevelopmental disorder, or

Toddlers-Revised with Follow-up (M- CHAT-R/F)  Autism Diagnostic Interview-Revised (ADI-R)  Gilliam Autism Rating Scale (GARS)  Childhood Autism Rating Scale, Second Edition (CARS2)  Autism Diagnostic Observation Schedule (ADOS) ADHD  Vanderbilt ADHD Teacher Rating Scale (VADTRS)  Vanderbilt ADHD Parent Rating Scale  Behavior Assessment System for Children -Second Edition (BASC-2)  Child Behavior Checklist/Teach Report Form (CBCL)  Conners’ Parent and Teacher Rating Scales Specific Learning Disorders  Reading o Scholastic Reading Inventory (SRI) o Woodcock Reading Mastery Test- Third Edition (WRMT-III) o Gray Oral Reading Test-Fifth Edition (GORT-5) o Test of Early Reading Ability-Third Edition (TERA-3)  Math o KeyMath-3 Diagnostic Assessment o Test of Mathematical Abilities- Third Edition (TOMA-3) Motor Disorders  Beery-Buktenica Developmental Test of Visual Motor Integration  Peabody Developmental Motor Scales- Second Edition (PDMS-2)  Pediatric Evaluation of Disability Inventory (PEDI)  Functional Independence Measure for Children (WeeFIM0  Vineland Adaptive Behavior Scales (VABS)  Bayley Scales of Infant Development II (BSID-II)  Movement Assessment of Infants (MAI)