Sunteți pe pagina 1din 18

Neurodevelopmental Disorder

- Disabilities associated primarily with the functioning of the neurological system and brain which affects emotion,
learning ability, self-control and memory and which unfolds as the individual grows. These are impairments of
the growth and development of the brain or central nervous system.
Types of Neurodevelopmental Disorder
1. Intellectual Disability or General Learning Disability – previously known as mental retardation. Characterized
by significantly impaired intellectual and adaptive functioning. It is defined by an IQ less than 70 and impairments
in life skills such as communication, self-care, home living, and social or interpersonal skills.
2. Autism Spectrum Disorder - are a group of developmental disabilities defined by significant social,
communication, and behavioral impairments. Although people with ASDs share some common symptoms, ASDs
affect different people in different ways, with some experiencing very mild symptoms and others experiencing
severe symptoms. Children with ASDs may lack interest in other people, have trouble showing or talking about
feelings, and avoid or resist physical contact. A range of communication problems are seen in children with ASDs:
some speak very well, while many children with an ASD do not speak at all. Another hallmark characteristic of
ASDs is the demonstration of restrictive or repetitive interests or behaviors, such as lining up toys, flapping hands,
rocking his or her body, or spinning in circles.139
3. Tic Disorder - are defined as repeated, sudden, rapid, non-rhythmic muscle movements including sounds or
a. Provisional tic disorder: Single or multiple motor and/or vocal tics have been present < 1 yr.
b. Persistent tic disorder (chronic tic disorder): Single or multiple motor or vocal tics (but not both
motor and vocal) have been present for > 1 yr.
c. Tourette syndrome (Gilles de la Tourette syndrome): Both motor and vocal tics have been present
for > 1 yr.
4. Communication, Language and Speech Disorders - Any disorder that affects an individual's ability to
comprehend, detect, or apply language and speech to engage in discourse effectively with others. The delays and
disorders can range from simple sound substitution to the inability to understand or use one's native language.
Examples: Aphasia, Dyslexia, Stuttering
5. Traumatic Brain Injury(Intracranial Injury) - Can result in physical, cognitive, social, emotional, and
behavioral symptoms, and outcome can range from complete recovery to permanent disability or death.
6. Attention-Deficit/Hyperactivity Disorder (ADHD) - A disruptive behavior disorder characterized by problems
paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age.
7. Down Syndrome(Trisomy 21) - Genetic disorder caused by the presence of all or part of a third copy of
chromosome 21. It is typically associated with physical growth delays, characteristic facial features, and mild to
moderate intellectual disability.
8. Minamata’s Disease - A neurological syndrome caused by severe mercury poisoning. Symptoms include ataxia,
numbness in the hands and feet, general muscle weakness, loss of peripheral vision, and damage to hearing and
speech. In extreme cases, insanity, paralysis, coma, and death follow within weeks of the onset of symptoms.
a. It was caused by the release of methylmercury in the industrial wastewater from the Chisso Corporation's
chemical factory, which continued from 1932 to 1968. This highly toxic chemical bioaccumulated in
shellfish and fish in Minamata Bay and the Shiranui Sea, which, when eaten by the local populace,
resulted in mercury poisoning. While cat, dog, pig, and human deaths continued for 36 years, the
government and company did little to prevent the pollution. The animal effects were severe enough in
cats that they came to be named as having "dancing cat fever".
Deprivation from social and emotional care causes severe delays in brain and cognitive development. Studies with
children growing up Romanian orphanages during Nicolae Ceauşescu's regime reveal profound effects of social
deprivation and language deprivation on the developing brain. These effects are time dependent. The longer children
stayed in negligent institutional care, the greater the consequences. By contrast, adoption at an early age mitigated
some of the effects of earlier institutionalization (abnormal psychology).
Genetic Disorders
A prominent example of a genetically determined neurodevelopmental disorder is Trisomy 21, also known as Down
syndrome. This disorder usually results from an extra chromosome 21, although in uncommon instances it is related
to other chromosomal abnormalities such as translocation of the genetic material. It is characterized by short stature,
epicanthal (eyelid) folds, abnormal fingerprints, and palm prints, heart defects, poor muscle tone (delay of neurological
development) and mental retardation (delay of intellectual development).
Less commonly known genetically determined neurodevelopmental disorders include Fragile X syndrome. Fragile X
syndrome was first described in 1943 by J.P. Martin and J. Bell, studying persons with family history of sex-linked
"mental defects". Rett syndrome, another X-linked disorder, produces severe functional limitations. Williams
syndrome is caused by small deletions of genetic material from chromosome 7. The most common recurrent Copy
Number Variannt disorder is 22q11.2 deletion syndrome (formerly DiGeorge or velocardiofacial syndrome), followed
by Prader-Willi syndrome and Angelman syndrome.
Infectious diseases
Systemic infections can result in neurodevelopmental consequences, when they occur in infancy and childhood of
humans, but would not be called a primary neurodevelopmental disorder per se, as for example HIV Infections of the
head and brain, like brain abscesses, meningitis or encephalitis have a high risk of causing neurodevelopmental
problems and eventually a disorder. For example, measles can progress to subacute sclerosing panencephalitis.
A number of infectious diseases can be transmitted either congenitally (before or at birth), and can cause serious
neurodevelopmental problems, as for example the viruses HSV, CMV, rubella (congenital rubella syndrome), Zika
virus, or bacteria like Treponema pallidum in congenital syphilis, which may progress to neurosyphilis if it remains
untreated. Protozoa like Plasmodium or Toxoplasma which can cause congenital toxoplasmosis with multiple cysts in
the brain and other organs, leading to a variety of neurological deficits.
Some cases of schizophrenia may be related to congenital infections though the majority are of unknown causes.
Metabolic disorders
Metabolic disorders in either the mother or the child can cause neurodevelopmental disorders. Two examples are
diabetes mellitus (a multifactorial disorder) and phenylketonuria (an inborn error of metabolism). Many such inherited
diseases may directly affect the child's metabolism and neural development but less commonly they can indirectly
affect the child during gestation. (See also teratology).
In a child, type 1 diabetes can produce neurodevelopmental damage by the effects of excess or insufficient glucose.
The problems continue and may worsen throughout childhood if the diabetes is not well controlled. Type 2 diabetes
may be preceded in its onset by impaired cognitive functioning.
A non-diabetic fetus can also be subjected to glucose effects if its mother has undetected gestational diabetes. Maternal
diabetes causes excessive birth size, making it harder for the infant to pass through the birth canal without injury or it
can directly produce early neurodevelopmental deficits. Usually the neurodevelopmental symptoms will decrease in
later childhood.
Phenylketonuria, also known as PKU, can induce neurodevelopmental problems and children with PKU require a
strict diet to prevent mental retardation and other disorders. In the maternal form of PKU, excessive maternal
phenylalanine can be absorbed by the fetus even if the fetus has not inherited the disease. This can produce mental
retardation and other disorders.
Nutrition disorders and nutritional deficits may cause neurodevelopmental disorders, such as spina bifida, and the
rarely occurring anencephaly, both of which are neural tube defects with malformation and dysfunction of the nervous
system and its supporting structures, leading to serious physical disability and emotional sequelae. The most common
nutritional cause of neural tube defects is folic acid deficiency in the mother, a B vitamin usually found in fruits,
vegetables, whole grains, and milk products. (Neural tube defects are also caused by medications and other
environmental causes, many of which interfere with folate metabolism, thus they are considered to have multifactorial
causes.) Another deficiency, iodine deficiency, produces a spectrum of neurodevelopmental disorders ranging from
mild emotional disturbance to severe mental retardation. (see also cretinism)
Excesses in both maternal and infant diets may cause disorders as well, with foods or food supplements proving toxic
in large amounts. For instance in 1973 K.L. Jones and D.W. Smith of the University of Washington Medical School
in Seattle found a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth
deficiency and developmental delay" in children of alcoholic mothers, now called fetal alcohol syndrome, It has
significant symptom overlap with several other entirely unrelated neurodevelopmental disorders. It has been
discovered that iron supplementation in baby formula can be linked to lowered I.Q. and other neurodevelopmental
Physical trauma
CT scan showing epidural hematoma, a type of traumatic brain injury (upper left)
Brain trauma in the developing human is a common cause (over 400,000 injuries per year in the US alone, without
clear information as to how many produce developmental sequellae) of neurodevelopmental syndromes. It may be
subdivided into two major categories, congenital injury (including injury resulting from otherwise uncomplicated
premature birth) and injury occurring in infancy or childhood. Common causes of congenital injury are asphyxia
(obstruction of the trachea), hypoxia (lack of oxygen to the brain) and the mechanical trauma of the birth process


 Updated term for ADD or Attention Deficit Disorder that was used to describe someone who can’t stay focus.
 ADD was evolved into ADHD to encompass or include more symptoms of that people with ADHD are often experience
which in addition to being inattentive, includes both hyperactivity and impulsiveness.
 ADHD is one of the most common neurodevelopment disorders of childhood. It is usually first diagnosed in childhood and
often lasts into adulthood.
 ADHD is marked by an ongoing pattern of inattention and/or impulsivity that interferes with functioning or development.


 According to the DSM-5, ADHD split into 3 subtypes:
 Both inattentive and hyperactive-impulsive have a set of 9 symptoms.
 A diagnosis is given when someone has 6 of the 9 symptoms of either inattentive or hyperactive-impulsive, for at least 6
 Specify whether:
a. Combined presentation: If both inattention and hyperactivity-impulsivity are met for the past 6 months.
b. Predominantly inattentive presentation: If inattention is met but hyperactivity-impulsivity is not met for the past
6 months.
c. Predominantly hyperactive/impulsive presentation: If hyperactivity-impulsivity is met and inattention is not
met for the past 6 months.
 Children with ADHD have persistent, severe and intense hyperactivity and impulsivity during early school years than those
children who are just energetic, friendly, and talkative.
 Symptoms of ADHD may lessen as a child gets older although inattention persists.

 Easily distracted  Forgets about daily activities
 Doesn’t follow directions or finish tasks  Has problems organizing daily tasks
 Doesn’t appear to be listening  Doesn’t like to do things that require
 Doesn’t pay attention and makes sitting still
careless mistakes  Often loses things
 Tends to daydream

 Often squirms, fidgets, or bounces when this is more commonly described as
sitting restlessness.)
 Doesn’t stay seated  Talks excessively
 Has trouble playing quietly  Is always “on the go” as if “driven by a
 Is always moving such as running or motor”
climbing on things (In teens and adults,

 Has trouble waiting for his/her turn
 Blurts out answers
 Interrupts others

 Chronic lateness and forgetfulness  Procrastination
 Anxiety  Easily frustrated
 Low self-esteem  Chronic boredom
 Problems at work  Trouble concentrating when reading
 Trouble controlling anger  Mood swings
 Impulsiveness  Depression
 Substance abuse or addiction  Relationship problems
 Unorganized

 At this point, researcher do not yet know the exact cause of ADHD but according to the result of the research studies, ADHD
highly influenced by:
 Environmental factors
- use of tobacco products
- use of alcohol during pregnancy
- exposure to high levels of lead in early childhood
 Genetic factors
- Hereditary
- Lower amount of neurotransmitters like dopamine (involves getting a reward, taking a risk or being
impulsive) and norepinephrine (involves in attention and arousal)
 But more studies are necessary to accurately pinpoint these causes.

 ADHD has no cure but there are ways or treatments that can lessen the symptoms, through:
 MEDICATION (biological interventions)
- Help to reduce the children’s impulsivity and hyperactivity and to improve their attention skills
- The first types of medication used for children with ADHD were stimulants that can help control
hyperactive and impulsive behavior and increase attention span and can help in improving
concentration o tasks. They include:
o Dexmethylphenidate (Focalin)
o Dextroamphetamine (Adderall, Dexederine)
o Lisdexamfetamine (Vyvanse)
o Methylphenidate (Concerta, Daytrana. Metadate, Methylin, Ritalin, Quilivant)

 THERAPY (psychosocial treatment)

- These treatments focus on changing behavior such as improving academic performance, decreasing
disruptive behavior, and improving social skills:
o Special education helps a child learn at school. Having structure and a routine can help
children with ADHD a lot.
o Behavior modification teaches ways to replace bad behaviors with good ones.
o Psychotherapy (counseling) can help someone with ADHD learn better ways to handle
their emotions and frustration. It can also help improve their self-esteem. This may also help
family members better understand the child or adult with ADHD.
o Social skills training can teach behaviors, such as taking turns and sharing which includes
teaching them how to interact appropriately with their peers.
o For adults with ADHD, Cognitive-behavioral therapy helps to reduce distractibility and
improve organizational skills.
 Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician such as pediatrician, psychologist, or
psychiatrist with expertise in ADHD.


-it is a pattern of angry/irritable mood or argumentative/defiant behavior or vindictiveness lasting at least 6 months. As
evidenced at least 4 symptoms from any of the following categories. Many children start to show symptoms of ood
between the ages of 6 and 8 years old.

It is really secondary to a bigger problem; anxiety, depression and some type of school related difficulty.


Angry and Irritable mood:

 Often and easily loses temper
 Is frequently touchy and easily annoyed by others
 Is often angry and resentful
Argumentative and defiant behavior:
 Often argues with adults or people in authority
 Often actively defies or refuses to comply with adults' requests or rules
 Often deliberately annoys or upsets people
 Often blames others for his or her mistakes or misbehavior
 Is often spiteful or vindictive
 Has shown spiteful or vindictive behavior at least twice in the past six months
 Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
 Moderate. Some symptoms occur in at least two settings.
 Severe. Some symptoms occur in three or more settings.
There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited
and environmental factors, including:
 Genetics — a child's natural disposition or temperament and possibly neurobiological differences in the way
nerves and the brain function
 Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh
discipline, or abuse or neglect
ODD may lead to problems such as:
 Poor school and work performance
 Antisocial behavior
 Impulse control problems
 Substance use disorder
 Suicide
 Behavioral Treatment (Cognitive Behavioral Therapy)
-involves learning skills to help build positive family interactions and to manage problematic behaviors.
Conduct disorder became established as a medical diagnosis in 1968. Today, they are one of the
most frequent reasons why children and adolescence are referred to a mental clinic. Conduct disorder
impact upon the emotional well-being of the individual, their social and family relationships, their
academic success at school and their future well being as adults in the society.

 The first clinical diagnosis of conduct problems appeared in 1968 in DSM II and in 1969 in The
International Classifications of Diseases (ICD-8) under the name “Behaviour Disorders of
childhood”. In 1980 the disorder seaparated in DSM III into 2 different diagnoses: Oppositional
Defiant Disorder and Conduct Disorder to distinguish between 2 different clusters of symptoms.
 The essential features of Conduct Disorder are concentrated around the violation of basic human
rights of others or major age-appropriate societal norms.
 Conduct Disorder is manifested by the presence of atleast 3 of the following 15 criteria in the past
12 months from any of the categories with atleast one criterion present in the past 6 months.

Different Criterion:
A. Aggression to people and animals
1. Often bullies, threatens or intimidates others.
2. Often initiates fights.
3. Has used weapon that can cause serious physical harm to others (ex. A bat, brick, bottle, knife, gun)
4. Has been physically cruel to animals.
5. Has been physically cruel to people.
6. Has stolen while confronting a victim (ex. Mugging, purse, snatching, extortion, armed robbery.
7. Has forced someone into sexual activity.
B. Destruction of properties
8. Has deliberately engaged into fire setting with the intention of causing serious damage.
9. Has deliberately destroyed others’ property (other than by fire setting).
C. Deceitfulness or theft
10. Has been into someone else’s house, building or car.
11. Often lies to obtain good or favors or to avoid obligations.
12. Has stolen items of nontrivial value without confronting a victim (ex. Shoplifting but without breaking
and entering, forgery).
D. Serious violations of rules
13. Often stays out at night despite parental prohibitions beginning before age 13 years.
14. Has run away from home overnight alteast twice while living in the parental/parental surrogate home,
once without returning for a lengthy period.
15. Is often truant from school, beginning before age 13 years.
Note: whenever they done these things they lack in remorse or guilt, and empathy, they are unconcerned
about their performance and they do not express/show feelings or emotions to others.
- Several common childhood psychiatric conditions have features similar to those of Conduct
Disorder but they have their own distinguishing features.


The distinguishing features of CD are persistent pattern of Chronic argumentativeness; refusal to comply with adult
violating rights of others and illegal acts. requests.

- Parental substance abuse, psychiatric illness, marital conflict, child abuse and neglected all
increase the risk of conduct disorder. Exposure to the antisocial behavior of a caregiver is a
particularly important risk factor.
- Inconsistent parental availability and discipline. As a result, children with Conduct Disorder do not
experience consistent relationship between their behavior and consequences.
- Person with conduct Disorder usually have a “hypertensive quasi- paranoid attitude” where they
interpret other’s intentions as threatening and therefore react with inappropriate hostility (Bird

1. Cognitive Behavior Therapy
- aims to reshape the child’s thinking (cognition) to improve problem solving skills, anger
management, moral reasoning skills and impulse control.
2. Family Therapy
- aims to improve family interactions and communication. A specialized therapy technique called
Parental Management Training (PMT) teaches parents ways to positively alter their child’s behavior in the
- it also tends to focus on helping parents understand how to be more effective and fair disciplinarians.
3. Pharmacotherapy
- conduct disorder is often comorbid with other conditions like mood disorder. While there are no
formally approved medications for conduct disorder, pharmacotherapy ,may help specific symptoms.
Language Disorders

Language Disorders or Language Impairments are disorders that involve the processing of linguistic information.
Problems that can be experienced may involve grammar (syntax and or morphology), semantics (meaning, or other
aspects of language). These are also neurodevelopment condition with onset during childhood development.

How common are Language Disorders?

 Five percent of school-age children are believed to have Language Disorder. This makes Language
Disorders some of the more common childhood disorders.
 According to studies, out of 6.1 million children, there are 1.1 million children who fell under the category of
having language impairment.

Types of Language Disorder:

1. Receptive Language Disorder – involves difficulty in understanding what others are saying.
2. Expressive Language Disorder – involves difficulty in expressing thoughts and ideas.
3. Mixed receptive-expressive Language Disorder – involves difficulty understanding and using of spoken

Symptoms of Language Disorder:

Problems with oral communication are the most sign of language disorders

DSM-5 Fifth Edition:

A. Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign
language, or other) due to deficits in comprehension and production that include the following:
1. Reduced vocabulary (word knowledge and use).
2. Limited sentence structure (ability to put words and word endings together to form sentences based on
the rules of grammar and morphology).
3. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic
or series of events or have a conversation).
B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional
limitation in effective communication, social participation, academic achievement, or occupational
performance, individually or in combination.
C. Onset of symptoms is in the early development period.
D. The difficulties are not attributable to hearing and other sensory impairment, motor dysfunction, or another
medical or neurological condition and are not better explained by intellectual disability or global development

Differential Diagnosis:

1. Normal variations in language – language disorders need to be distinguished from normal development
variations and this distinction is difficult to make before 4 years of age.
2. Hearing or other sensory impairment –needs to be excluded as primary cause of language deficit.
3. Intellectual disability – diagnosis of language disorder cannot be made unless language difficulties are in
excess of intellectual limitations.

Causes of Language Disorders:

1. Gene and Heredity – research has found that 20 to 40 percent of children with a family history of speech
and language impairment have the condition themselves.
2. Prenatal conditions – some research has shown that when woman takes prenatal folic acid supplements
during pregnancy, her baby is less likely to have severe language disorders because folic acid prevents
neural tube defects and it helps the brain to be fully developed during pregnancy.
3. Other conditions – Autism Spectrum Disorder, Down syndrome, Intellectual Disabilities and premature birth
might also cause language disorder.

How can professionals help with Language Disorder?

1. Individual Speech Therapy – a speech therapist can work one-on-one with the child to build his vocabulary
and improve his grammar.
2. Psychotherapy – if the child has emotional difficulties as a result of language issues, it is recommended for
the child to take psychological therapy.

Case study:

Initial assessment showed a Psychologist that a 6-year-old boy was a happy and sociable communicator although he
preferred to follow his own agenda if possible. He used sentences to communicate with very clear pronunciation. He
showed delayed attention skills so that he was often not able to follow simple instructions for almost two years now,
he became 'tuned out' or distractible. His play and social skills were limited. Also, the little boy could hardly
comprehend what others were telling him. What do you think is the condition of the little boy?

Answer: The child has a receptive language disorder.


DSM-5 Fifth Edition (APA)


According to DSM 5:

DIAGNOSTIC CRITERIA: A. Disturbances in normal fluency and time patterning of speech characterized by 1 or more
of the following:

1. Sound and syllable repetitions.

Ex.: The b-b-baby My p-p-pencil

2. Sound prolongations. (Consonants and vowels)

Sssssssometimes I watch horror movies. I ssssssssaw him yesterday.

3. Broken words.
(Pauses within a word)


Pau…ses My pencil is bro….ken.

4. Audible or silent blocking. (filled or unfilled pauses in speech)


I am g-(pause)-oing home. I have uh 5 pets.

5. Circumlocutions
6. Words produced with an excess of physical tension.
7. Monosyllabic whole-word repetitions.
I-I-I-I want ice cream. But-but-but but I don’t want cake.
Why-why-why- is he there?
NOTE: Examples are not taken from the DSM 5.

B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation or
academic or occupational performance individually or in any combination.

C. The onset of symptoms is in the early developmental period.

The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult
or another medical condition and not better explained by another mental disorder.


 Attempt to avoid dysfluencies by linguistic mechanisms.

 Avoiding certain speech situation.
 May be accompanied by motor movements
 Stress and anxiety have been shown to exacerbate dysfluency.

 Occurs by age 6 for 80%-90% of affected individuals, with age at onset ranging from 2-7 years.

 First-degree biological relatives of individuals with childhood onset fluency disorder is more than three times
the risk in general population.


According to DSM 5:

Diagnostic Criteria:

A: Persistent difficulties in the social use of verbal and nonverbal communication as manifested by the

1. Deficits I using communication for social purposes.

2. Impairment of the ability to change communication to match context or the needs of the listener.
3. Difficulty following rules of conversation and storytelling.
4. Difficulty understanding what is not explicitly stated.
B. Deficits result in functional limitations in effective communication.

C. Onset of symptoms is in early developmental period.

D. Symptoms are not attributable to another medical condition or neurological condition or to low abilities in the domain
of word structure and grammar and are not better explained by ASD, intellectual disability or another mental disorder.

 Language impairment
 May avoid social interactions
 ADHD, behavioral problems and SLD are common in affected individuals.

 Rare among children younger than 4 years.


Family history of ASD, communication disorders and SLD appears to increase the risk.


Communication Disorders are problems of childhood that affect learning, language, and/or speech.

Characteristics of Pupils with Communication Disorders

According to Brice (2012), Children with communication problems present many different symptoms. Some of such
symptoms include:

 difficulty in following directions  problems in understanding what was said

 problems in pronouncing words  and challenges of being understood
 failing to express oneself because of a stutter or a hoarse voice.
 problems in paying attention to a
Their problems with language involve difficulty:

 in learning new vocabulary  comprehending spoken or read material

 understanding questions  learning the alphabet
 expressing ideas coherently  identifying sounds that correspond to
 following directions letters
 recalling information  perceiving the correct order of letters in
 understanding and remembering words
something that has just been said  and possibly, spelling.
 reading at a satisfactory pace
Academic Problems that may encounter:

 Issues Learning
 Bullying
 Academic Failures
 Underachievement
 Lack of attention of teachers

Their difficulties with speech may include being unintelligible due to a motor problem or due to poor learning.
Sounding hoarse, breathy or harsh may be due to a voice problem. Stuttering also affects speech intelligibility
because the child's flow of speech is interrupted. According to Brice (2012), many of the communication problems
can be improved by therapy.

There are several levels of support for children with intellectual disabilities. The mental health professional will
assess the severity of disability based on the level of support the child needs to succeed and function in daily life:

 Intermittent support – people with mild intellectual disability typically do not need regular, scheduled
assistance. They do need intermittent support for certain situations and when they become exposed to new
environments and challenges.
 Limited support – people with moderate intellectual disability need assistance and training so they can
increase their functioning in social situations and in self-care. Some people in this category may need
assistance to cope with everyday situations, though.
 Extensive support – people who need extensive support typically have severe intellectual disability. They
have very limited communication ability and can only perform some of the necessary daily self-care duties.
They usually need daily support and assistance.
 Pervasive support – people with profound intellectual disability need this level of support, which entails
24-hour supervision and assistance. Those with profound intellectual disability require constant supervision
to ensure their health and safety.

The speech treatment plan developed for your child will vary depending on the subtype of communication disorder
that he or she has, as well as on other factors such as your child's intellectual ability, behavior, and personality.

There are essentially three main goals for communication disorder treatments: 1) to help children to develop and
improve their communication abilities, 2) to help children develop coping strategies and alternative communication
options enabling them to compensate for times when their communications abilities are insufficient, and 3) to help
children get used to using and practicing their communication skills and coping strategies in real-world environments
such as home, at school, and with friends.

The most known treatment that applies to those children with Communication Disorder is the Individual Speech-
Language Therapy. This professional speech-language pathologists work with children individually to provide
intensive, one-on-one, family-centered therapeutic intervention.

In conjunction with parents and caregivers, our speech-language pathologists will develop and individualize a
therapy plan with short- and long-term goals addressing specific areas of need.

In conclusion, therefore, working with children with communication disorders is a challenge that requires well-
trained and experienced professionals. In these circumstances, teachers can be of great help if they learn about the
particular speech and language disorder afflicting the student. In permitting environments the teachers then follow
applicable specific teaching strategies, and work cooperatively with the child’s speech therapist either within the
classroom setting or externally. It has been observed that in many cases, a child with speech problems will achieve
normal language development and outgrow their issues by adulthood, especially with the proper support and
DSM-5 Category: Neurodevelopmental Disorder


Unspecified Communication Disorder (UCD) is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth
edition), diagnosis assigned to individuals who are experiencing symptoms of a Communication Disorder. This
diagnostic category applies to a clinical presentations in which symptoms of a communication disorder are present,
but do not meet a sufficient number of the diagnostic criteria for a communication disorder to warrant a more specific
diagnosis. The symptoms have a significant impact on social, occupational/educational/interpersonal, or other critical
areas of functioning. The UCD diagnostic category is used when “ the clinician chooses not to specify the reason that
the criteria are not met for communication disorder or for a specific neurodevelopmental disorder” and can includes a
clinical picture in which there is insufficient data to render a more specific diagnosis (American Psychiatric
Association, 2013). It is noted by Nichols (2013) that Unspecified diagnostic codes are appropriate when the clinician
requires a consult, as they do not have the skill-level to specify a diagnosis, or when further evaluation is needed.

A Communication disorder can be broadly defined, and may have multiple presentations involving difficulties with
reception, production, processing, or comprehension, of verbal or written communication. It can be defined in terms of
severity from mild to profound, may be first apparent in childhood, with genetic etiology, or acquired through
environmental influences at any point in development (American Speech-Language-Hearing Association, 2014).

Symptoms of Unspecified Communication Disorder

According to the DSM-5, (American Psychiatric Association, 2013), there are four subtypes of Communication
Disorders specified:
 Language Disorder

 Speech Sound Disorder

 Childhood Onset Fluency Disorder (Stuttering)

 Social (Pragmatic) Communication Disorder

Symptoms of UCD do not fulfill the required diagnostic criteria for any one of the above disorders, (American
Psychiatric Association, 2013), but the UCD diagnosis is applied when the clinician suspects a Communication
disorder is present. An example would be a child who exhibits a transient stutter while anxious, which is leading to
peer abuse, and further anxiety about attending school.

Risk Factors for Unspecified Communication Disorder

The DSM-5 does not specify risk factors for UCD (American Psychiatric Association, 2013). The risk factors are
diverse, as the causality of Communication disorders are varied. It is noted that there is a correlation with productive
language deficits in children and maternal gestational diabetes (Krakowiak, Walker, C.K., Baker, Ozonoff, Hansen,
and Hertz-Picciotto, 2012), however causality is uncertain.

Onset of Unspecified Communication Disorder

The DSM-5 does not specify the age of onset of UCD. Communication disorders are part of the neurodevelopmental
disorder spectrum, so the typical age of onset will be early childhood (American Psychiatric Association, 2013).

Differential Diagnosis in Unspecified Communication Disorder

There are multiple diagnostic rule-outs to consider in UCD. Some are normal variations in language, which the
clinician must take care not to pathologize. As with all DSM-5 disorders, the basic criteria of at least some degree of
functional impairment in a major life area, and distress must be exhibited. Others are conditions that are comorbid
with Communication disorders include:

 Normal variations in language: There are normal variations in language that can be linked to one’s accent,
based on geographic location or origin. (American Speech-Language-Hearing Association, 2014). Words in
one language are filtered through another, and pronounced differently according to regional norms. For
example, in Northern Vermont, the word Time is often pronounced with an “Oy” sound in the middle, due to
filtering through French, whereas in neighboring upstate New York State, the same word is pronounced with
an “Eye” sound. Contractions specific to a region may also be employed. A common affirmative in New
England is “Ah-yep”, meaning, Ah, Yes.

 Hearing or other sensory impairment: Hearing impairment is a possible rule-out for a communication
disorder, as are other sensory or motor deficits than can interfere with productive or receptive speech.

 Intellectual disability (Intellectual developmental disorder): A delay in productive speech or difficulty

comprehending receptive speech can be an expression of an intellectual disability.

 Neurological disorders: A Communication disorder can develop due to neurological disorders, including
epilepsy syndrome.

 TBI (Traumatic Brain injury): Acquired deficits in productive or receptive speech can result from a TBI
effecting Broca’s or Wernicke’s areas, respectively. This would not be classified as a Communication
disorder, as it is not of a neurodevelopmental nature.

 Structural deficits: Productive Speech can be impaired due to maxilla -facial structural defects, such a cleft

 Dysarthria: Productive Speech impairment can be attributed to a motor disorder, such as CP (Cerebral

 Selective mutism: Children- as well as adults or older teens- may not speak under certain circumstances
secondary to anxiety, angry refusal to communicate, or as a deliberate passive-aggressive behavior.

 Medication side effects: Impairment of productive speech can be attributed to a side effect of a medication,
as can difficulty comprehending receptive speech due to medication induced cognitive impairment.
 Adult-onset dysfluencies: If the onset of a productive speech disorder occurs during or after the teen years,
is diagnosable as an Adult-onset communication disorder, rather than a neurodevelopmental disorder.

 Tourette’s disorder: Gille de Tourette’s syndrome involves phonic tics that are of a different quality than the
diagnostic features of a communication disorder (American Psychiatric Association, 2013).

 Attention-Deficit/Hyperactivity Disorder: AD/HD may manifest as problems in communication due to

inattentiveness. The causality is complex, in that a child may have AD/HD independent of symptoms of any
type of communication disorder, including UCD. AD/HD is part of the spectrum of neurodevelopmental
disorders associated with Communication disorders, AD/HD is also identified as being causal, or as an
exacerbating factor in communication disorders, due to impaired or delayed acquisition of reading and
writing skills (St. Pourcain, Mandy, Heron, Golding, Smith, and Skuse, 2011)

 Social anxiety disorder (social phobia): The diagnostic features of social communication disorder overlap
with the symptoms of social anxiety disorder, but are differentiated in that there is no history of normal social
communication in the former (American Psychiatric Association, 2013).

Treatment of Unspecified Communication Disorder

The DSM-5 does not specify treatment methods for UCD (American Psychiatric Association, 2013). UCD can be
treated with speech therapy if the symptoms are indicative of productive speech impairment. Depending on the
severity of the symptoms, or later diagnostic clarity of a more serious disorder and the degree of impairment, psycho-
education for the family may be beneficial. More in-depth family therapy may be needed, as there can be
considerable stressors associated with a special needs child.

Prognosis of Unspecified Communication Disorder

The DSM-5 does not specify the prognosis for UCD (American Psychiatric Association, 2013). The prognosis will
depend on a more clarified diagnosis, or if the etiology of a difficult to categorize Communication Disorder can be
determined. The impact of comorbid conditions will also determine prognosis. It is noted that LD’s (Language
Disorders) are specifically predictive of various forms of psychopathology from childhood to young adulthood
(Toppelberg, 2014). Disruption in the normal development of communication is associated with the
neurodevelopmental disorders spectrum, of which communication disorders are integral. Profound difficulties with
communication can have a pervasive impact on development. Communication is critical to a child’s development into
a healthy, functioning adult, particularly in the areas of:

 Cognitive-intellectual development and later academic and occupational achievement.

 Social- Emotional development and interpersonal relationships.

 General ability to adapt to the environment and situations.

Academic achievement is dependent mostly on the ability to read the written word, view and comprehend images,
and hear and comprehend speech. The ability to communicate understanding and knowledge is also fundamental to
learning. The inability to perform these tasks can limit an appreciation of the world around one, future employment
opportunities, socialization, and negatively affect self-esteem, diminish self-respect, and lead to inadequacy,
frustration, and depression. Proper diagnosis and treatment can prevent a multitude of problems later in life.


Motor disorders are disorders of the nervous system that cause abnormal and involuntary movements. They can
result from damage to the motor system.
Motor disorders are defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) –
published in 2013 to replace the fourth text revision (DSM-IV-TR) – as a new sub-category of neurodevelopmental
disorders. The DSM-5 motor disorders include developmental coordination disorder, stereotypic movement disorder,
and the tic disorders including Tourette syndrome.

Motor disorders are malfunctions of the nervous system that cause involuntary or uncontrollable movements or
actions of the body. These disorders can cause lack of intended movement or an excess of involuntary movement.
Symptoms of motor disorders include tremors, jerks, twitches, spasms, contractions, or gait problems.
Tremor is the uncontrollable shaking of an arm or a leg. Twitches or jerks of body parts may occur due to a startling
sound or unexpected, sudden pain. Spasms and contractions are temporary abnormal resting positions of hands or
feet. Spasms are temporary while contractions could be permanent. Gait problems are problems with the way one
walks or runs. This can mean an unsteady pace or dragging of the feet along with other possible irregularities.

Pathological changes of certain areas of the brain are the main causes of most motor disorders. Causes of motor
disorders by genetic mutation usually affect the cerebrum. The way humans move requires many parts of the brain to
work together to perform a complex process. The brain must send signals to the muscles instructing them to perform
a certain action. There are constant signals being sent to and from the brain and the muscles that regulate the details
of the movement such as speed and direction, so when a certain part of the brain malfunctions, the signals can be
incorrect or uncontrollable causing involuntary or uncontrollable actions or movements.

Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) - DYSPRAXIA

- occurs when a delay in the development of motor skills, or difficulty coordinating movements, results in a child
being unable to perform everyday tasks.
- DCD is believed to affect 5-6% of children who are school aged and tends to occur more frequently in boys. DCD
can exist on its own or it may be present in a child who also has learning disabilities, speech/language
impairments and/or attention deficit disorder.
- This condition can be considered a childhood disorder, but the effects of DCD continue into adulthood.

Diagnostic Criteria

DCD is difficult to diagnose because the symptoms may be confused with those of other conditions. The Diagnostic
and Statistical Manual of Mental Disorders (DSM-V) lists four criteria that must be met for a diagnosis of DCD:

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

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 affects 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 neurologic condition affecting movement (e.g., cerebral palsy,
muscular dystrophy, degenerative disorder).


Signs of DCD can appear soon after birth. Newborns may have trouble learning how to suck and swallow milk. Toddlers
may be slow to learn to roll over, sit, crawl, walk, and talk.

As they enter school, symptoms of the disorder may become more noticeable. Symptoms of DCD may include:

 an unsteady walk  frequent tripping

 difficulty going down stairs  difficulty tying shoes, putting on clothes, and
other self-care activities
 dropping objects
 difficulty performing school activities such as
 running into others writing, coloring, and using scissors
People with DCD may become self-conscious and withdraw from sports or social activities. However, limited exercise
can lead to poor muscle tone and weight gain. Maintaining social involvement and good physical condition is essential
for overcoming the challenges of DCD.


The causes of DCD are not well-understood, but researchers believe that it is the result of delayed brain development.
People with DCD generally have no other medical issues that can explain the disorder. In some cases, DCD can occur
with other disorders, such as attention deficit hyperactivity disorder or disorders that cause intellectual disabilities.
However, these conditions aren’t linked.


Developmental coordination disorder (DCD) can't be cured, but there are ways that help the child to manage their

The Role of the Occupational Therapist

In today’s health care environment, the occupational therapist (OT) is often primarily a consultant.

The OT will observe and assess the child and then make recommendations to his/her parents and teachers. These
recommendations may include: specific strategies or accommodations for handwriting and other classroom tasks; tips
to make dressing and feeding easier; activities to improve the child's motor coordination; ideas for community leisure
and sports activities; and setting appropriate expectations to ensure that the child experiences success.

The Role of the Teacher and Parent

At Home

1. Encourage the child to participate in games and sports that are interesting to him/her and which provide practice in,
and exposure to, motor activities. Physical activity and enjoyment should be emphasized rather than proficiency or

2. Try to introduce the child to new sports activities or a new playground on an individual basis, before s/he is required
to manage the activity in a group.

3. The child may exhibit a preference for, and perform better at, individual sports (e.g., swimming, running, bicycling,
skiing) rather than team sports. If this is the case, then try to encourage the child to interact with peers through other
activities that are likely to be successful (e.g., cubs, music, drama, or art).

4. Encourage the child to wear clothing to school that is easy to get on and off.

5. Encourage the child to participate in practical activities that will help improve his/her ability to plan and organize
motor tasks. For example, setting the table, making lunch, or organizing a knapsack. Ask questions that help the child
focus on the sequence of steps (e.g., “What do you need to do first?”). Recognize that, if your child is becoming
frustrated, it may be time to help or to give specific guidance and direction.

6. Recognize and reinforce the child’s strengths. Many children with DCD demonstrate strong abilities in other areas
such as: advanced reading skills, creative imaginations, sensitivity to the needs of others, and/or strong oral
communication skills.

At School

In the Classroom:

1. Ensure that the child is positioned properly to begin table work. Make sure that the child's feet are flat on the floor,
that the desk is at the appropriate height, and that forearms are comfortably supported on the desk.

2. Try to set realistic short-term goals. This will ensure that both the child and teacher continue to be motivated.

3. Try to provide the child with extra time to complete fine motor activities such as math, printing, writing a story, practical
science tasks, and artwork. If speed is necessary, be willing to accept a less accurate product.

4. When copying is not the emphasis, try to provide the child with prepared worksheets that will allow him/her to focus
on the task. For example, provide children with prepared math sheets, pages with questions already printed, or 'fill in
the blank' for reading comprehension questions. For study purposes, photocopy notes written by another child.
5. Introduce computers as early as possible to reduce the amount of handwriting that will be required in higher grades.
Although keyboarding may be difficult initially, it is a very beneficial skill and is one at which children with movement
problems can become quite proficient.

6. Teach children specific handwriting strategies that encourage them to print or write letters in a consistent manner.
Use thin magic markers or pencil grips if they seem to help the child improve pencil grasp or to reduce pencil pressure
on the page.

7. Use paper that matches the child's handwriting difficulties. For example: i) Widely spaced lines for a child who writes
very large; ii) Raised, lined paper for a child who has trouble writing within the lines; iii) Graph paper for a child whose
writing is too large or improperly spaced; iv) Graph paper with large squares for a child who has trouble keeping
numbers aligned in mathematics.

8. Try to focus on the purpose of the lesson. If a creative story is the goal, then ignore messy handwriting, uneven
spacing and multiple erasures. If the goal is to have the child learn to set up a math problem correctly, then allow time
to do it even if the math problem does not get solved.

9. Consider using alternative methods of presentation in order for the child to demonstrate comprehension of a subject.
For example, children may present a report orally, use drawings to illustrate their thoughts, type a story or report on the
computer, record a story or exam on a tape recorder.

10. Consider allowing the child to use the computer for draft and final copies of reports, stories and other assignments.
If the teacher wants to see the “non-edited” product, ask the child to submit both the draft and final versions.

11. When possible, allow the child to dictate stories, book reports, or answers to comprehension questions to the
teacher, a volunteer or another child. For older children, voice recognition software can be introduced as soon as the
child’s voice patterns have matured enough that they are consistent.

12. Provide additional time, and/or computer access, for tests and exams that require a lot of written output.

In Physical Education:

1. Break down the gym activity into smaller parts while ensuring that each part is meaningful and achievable.

2. Try to choose activities that will ensure success for the child at least 50% of the time. Reward effort, not skill.

3. Try to incorporate activities which require a coordinated response from arms and/or legs (e.g., skipping, bouncing
and catching a large ball). Also encourage children to develop skills using their hands in a dominant/assistant fashion
(e.g., using a baseball bat or a hockey stick).

4. Keep the environment as predictable as possible when teaching a new skill (e.g., place a ball on a T-ball stand).
Introduce changes gradually after each part of the skill has been mastered.

5. Make participation, not competition, the major goals. With fitness and skill-building activities, encourage children to
compete with themselves, not others.

6. Allow the child to take on a leadership role in gym activities (e.g., captain of the team, umpire). The child may develop
organizational or managerial skills that are also useful.

7. Modify equipment to decrease the stress and risk of injury to children who are learning a new skill. For example, Nerf
balls in graduated sizes can be used to develop catching and throwing skills.

8. When possible, provide hand-over-hand guidance to help the child get the feel of the movement. This can be done,
for example, by asking the child to help the teacher demonstrate a new skill to the class. Also, talk aloud when teaching
a new skill, describing each step clearly.

9. Focus on understanding the purpose and the rules of various sports or physical activities. When a child understands
clearly what s/he needs to do, it is easier to plan the movement.

10. Give positive, encouraging feedback whenever possible. If providing instruction, describe the movement changes
specifically (e.g., you need to lift your arms higher).

Stereotypic Movement Disorder

Stereotypic movement disorder is a motor disorder that develops in childhood and involves repetitive, purposeless
movement. Examples of stereotypic movement include hand waving, body rocking, and head banging. A diagnosis is
only given if the repetitive movement causes distress in a child and leads to some impairment in day-to-day functioning.

Simple stereotypic movements such as rocking are common in young children and do not indicate a movement
disorder. Complex stereotypic movements, however, are much less common and only occur in 3 to 4 percent of
children. Motor stereotypies are often diagnosed in people with intellectual disabilities and neurodevelopmental
conditions but can also be found in typically developing children.


Movement that is repetitive and purposeless is called stereotypic movement. Stereotypic movements can include the

 Hand shaking, waving, or wringing  Skin picking

 Head banging  Body rocking
 Self-hitting  Thumb sucking
 Self-biting  Head nodding
 Nail biting  Face slapping
 Flicking or fluttering fingers in front of the face

The type of repetitive movement varies widely and each child presents with their own individually patterned, “signature”
behavior. The repetitive movements may increase with boredom, stress, excitement, and exhaustion. Some children
may stop their movements if attention is directed toward them or they are distracted, while others may not be able to
stop their repetitive movement.


Stereotypic movements are typically first seen within the first three years of life. The cause of stereotypic movement
disorder is unknown, but there are several factors that have been connected to the development of this condition. Social
isolation, for example, may lead to self-stimulation in the form of stereotypic movements. Environmental stress, such
as difficulty in the home or school environment, can also trigger stereotypic behavior. Additionally, there may be a
genetic component to the development of the condition. The risk for stereotypic movement disorder is greater among
individuals with severe intellectual disability. In typically developing children, stereotypic movements can usually be
suppressed or end up lessening over time. Among people with intellectual disability, however, the stereotyped, self-
injurious behaviors can last for many years.

Stereotypic movements may develop with certain medications and typically go away once the medication is stopped.
Stereotypic movements due to severe head injury may be permanent.


Stereotypic movement disorder can be diagnosed by a healthcare professional during a physical examination.
Treatment may include psychotherapy and behavioral strategies to reduce repetitive movements and minimize the risk
for self-harm. Medications may also be an option, although prescription medication is not typically used for pediatric
patients with less severe forms of stereotypic movement disorder because the side effects may outweigh the benefits.
As with many conditions affecting children, early identification and treatment leads to better outcomes.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).


Behavioral method "Differential Reinforcement of Other Behaviors" (or DRO). A related technique is known as
"Differential Reinforcement of Incompatible/Alternate Behaviors" (or DRI/DRA). Both methods use rewards
(reinforcements) in order to increase the likelihood that children will act in a particular manner in the future.

The DRO method works by rewarding children when they act in socially appropriate ways (such as when they talk with
a parent or play a game without engaging in stereotyped movements). In contrast, children treated with the DRI/DRA
method are rewarded when they behave in ways that are incompatible with the stereotyped behaviors that the treatment
seeks to suppress. For example, children who are being treated to decrease thumb twiddling would be rewarded only
when engaging in a task that requires a different use of their hands (it is impossible to twiddle your thumbs when you
are writing a letter, or otherwise occupying your hands). Were the same children to be rewarded according to the DRO
scheme, they would get would get rewards for letter writing, as well as for having a conversation during which no thumb
twiddling occurs.

Functional Communication Training (or FCT). In FCT, children are taught to replace undesired behaviors with
appropriate verbal activities. For example, children who engage in hand flapping behavior might be trained to say
"Excuse Me" when they want to say something during a discussion. The child's act of concentrating on saying "Excuse
Me" (an appropriate behavior) makes it easier for them to not hand flap. If it becomes clear that a child's unwanted
behavior occurs more frequently when he or she is anxious, relaxation techniques (e.g., breathing exercises or
meditation) can complement the above behavior replacement strategy.

Psychopharmacological treatments can also be used to treat Stereotypic Movement Disorder. Atypical antipsychotic
drugs such Risperdal and Clozaril (usually used to treat schiozphrenia and mood disorders) and opiate antagonists
such as Naltrexone (usually used to treat heroin and opioid addictions) can lessen children's symptoms, but may also
result in unwanted side effects such as apathy, sedation, weight gain, confusion, or even hallucinations (seeing,
hearing, smelling, etc. things that are not truly there). It is always a good idea to talk with your doctor about the full
range of risks and benefits associated with recommended medications before agreeing to allow your child to take them.

Diagnostic criteria :

A. Repetitive seemingly driven, and apparently purposeless motor behavior.

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).

Specify if:

With self-injurious behavior (or behavior that would result in an injury if preventive measures were not used).

Without self-injurious behavior

Specify current severity:

Mild: Symptoms are easily suppressed but sensory stimulus or distraction.

Moderate: Symptoms require explicit protective measures and behavioral modification.

Severe: Continuous monitoring and protective measures are required to prevent serious injury.

Reference: DSM-5, APA