Developmental disorder

Developmental disorder
Classification and external resources
Specialty Psychiatry
ICD-10 F80-F84
ICD-9-CM 299, 315

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term.[1] The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10.[1] These disorders comprise language disorders, learning disorders, motor disorders and autism spectrum disorders.[2] In broader definitions ADHD is included, and the term used is neurodevelopmental disorders.[1] Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life.[1] However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.[1]

Developmental disorders are present from early life. Most improve as the child grows older, but some entail impairments that continue throughout life. There is a strong genetic component; more males are afflicted than females.[1]

Emergence

Learning disabilities are diagnosed when the children are young and just beginning school. Most learning disabilities are found under the age of 9.[3]

Young children with communication disorders may not speak at all, or may have a limited vocabulary for their age.[4] Some children with communication disorders have difficulty understanding simple directions or are unable to name objects.[4] Most children with communication disorders are able to speak by the time they enter school, however, they continue to have problems with communication.[4] School-aged children often have problems understanding and formulating words.[4] Teens may have more difficulty with understanding or expressing abstract ideas.[4]

Causes

The scientific study of the causes of developmental disorders involves many different theories. Some of the major differences between these theories involves whether or not environment disrupts normal development, or if abnormalities are pre-determined.[5] Normal development occurs with a combination of contributions from both the environment and genetics. The theories vary in the part each factor has to play in normal development, thus affecting how the abnormalities are caused.[5]

One theory that supports environmental causes of developmental disorders involves stress in early childhood. Researcher and child psychiatrist Bruce D. Perry, M.D., Ph.D, theorizes that developmental disorders can be caused by early childhood traumatization.[6] In his works he compares developmental disorders in traumatized children to adults with post-traumatic stress disorder, linking extreme environmental stress to the cause of developmental difficulties.[6] Other stress theories suggest that even small stresses can accumulate to result in emotional, behavioral, or social disorders in children.[7]

A 2017 study[8][9] tested all 20,000 genes in about 4,300 families with children with rare developmental difficulties in the UK and Ireland in order to identify if these difficulties had a genetic cause.They found 14 new developmental disorders caused by spontaneous genetic mutations not found in either parent (such as a fault in the CDK13 gene). They estimated that about one in 300 children are born with spontaneous genetic mutations associated with rare developmental disorders.[10]

Types

Autism spectrum disorder (ASD)

Diagnosis

The first diagnosed case of ASD was published in 1943 by American psychiatrist Leo Kanner. There is a wide range of cases and severity to ASD so it is very hard to detect the first signs of ASD. A diagnosis of ASD can be made accurately before the child is 3 years old, but the diagnosis of ASD is not commonly confirmed until the child is somewhat older. The age of diagnosis can range from 9 months to 14 years, and the mean age is 4 years old in the USA.[11] On average each case of ASD is tested at three different diagnostic centers before confirmed. Early diagnosis of the disorder can diminish familial stress, speed up referral to special educational programs and influence family planning.[12]

In the brain

The cause of ASD is still uncertain. Autism spectrum disorder is a disorder of the cortex, which controls higher functions, sensation, muscle movements, and memory. What is known is that a child with ASD has a pervasive problem with how the brain is wired. The distribution of white matter, the nerve fibers that link diverse parts of the brain, is abnormal. An ASD child’s brain grows at a very rapid rate and is almost fully grown by the age of 10.[12] Recent fMRI studies have also found altered connectivity within the social brain areas due to ASD and may be related to the social impairments encountered in ASD.[13][14]

Symptoms

Still a lot of information is unclear about ASD and the symptoms have a wide range of severity. Signs include impairments in social interactions, communication and repetitive or restricted patterns of interest or behaviors. There are also different symptoms at different ages based on developmental milestones. Children between 0 and 36 months with ASD show a lack of eye contact, seem to be deaf, lack a social smile, do not like being touched or held, have unusual sensory behavior and show a lack of imitation. Children between 12 and 24 months with ASD show a lack of gestures, prefer to be alone, do not point to objects to indicate interest, are easily frustrated with challenges, and lack of functional play. And finally children between the ages 24 to 36 months with ASD show a lack of symbolic play and an unusual interest in certain objects, or moving objects.[12]

Treatment

There is no cure for ASD and proper treatment depends on the case and what is most struggled with. Autism spectrum disorder is like many other disorders where when diagnosed early, can be better treated. Different types of therapy are helpful such as music therapy and physical therapy. Other treatments include auditory training, discrete trial training, facilitated communication, and sensory integration therapy.[12]

Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder is a neurodevelopmental disorder that is characterised by significant levels of hyperactivity, inattentiveness, and impulsiveness. There are three subtypes of ADHD: predominantly inattentive, predominantly hyperactive, and combined (which presents as both hyperactive and inattentive subtypes).[15]

Treatment options

Treatment of ADHD often includes a combination of psychological, behavioural, pharmaceutical and educational advice and interventions.

Medications commonly used in the treatment of ADHD are primarily stimulants such as methylphenidate and lisdexamphetamine and non-stimulants such as atomoxetine.

SSRI antidepressants may be unhelpful, and could worsen symptoms of ADHD.[16] However ADHD is often misdiagnosed as depression, particularly when no hyperactivity is present.

Symptoms

Symptoms of ADHD include inattentiveness, impulsiveness, and hyperactivity. Many of the behaviors that are associated with ADHD include poor control over actions resulting in disruptive behavior and academic problems. Another area that is affected by these disorders is the social arena for the person with the disorder. Many children that have this disorder exhibit poor interpersonal relationships and struggle to fit in socially with their peers.[15]

Other disorders

See also

References

  1. 1 2 3 4 5 6 Michael Rutter, Dorothy V. M. Bishop, Daniel S. Pine, Stephen Scott, Jim Stevenson, Eric Taylor, Anita Thapar, eds. (2008). Rutter's Child and Adolescent Psychiatry, Fifth Edition. Dorothy Bishop and Michael Rutter. Blackwell Publishing Ltd. pp. 32–33. ISBN 978-1-4051-4549-7.
  2. ↑ "ICD 10". priory.com.
  3. ↑ National, Disabilities Learning (1982). "Learning disabilities: Issues on definition". Asha. 24 (11): 945–947.
  4. 1 2 3 4 5 Communication Disorders. (n.d.). Children's Hospital of Wisconsin in Milwaukee, WI, Retrieved December 6, 2011, from http://www.chw.org/display/PPF/DocID/
  5. 1 2 Karmiloff Annette (October 1998). "Development itself is key to understanding developmental disorders". Trends in Cognitive Sciences. 2: 389–398. doi:10.1016/S1364-6613(98)01230-3. PMID 21227254.
  6. 1 2 Perry, Bruce D. and Szalavitz, Maia. "The Boy Who Was Raised As A Dog", Basic Books, 2006, p.2. ISBN 978-0-465-05653-8
  7. ↑ Payne, Kim John. “Simplicity Parenting: Using the Extraordinary Power of Less to Raise Calmer, Happier, and More Secure Kids”, Ballantine Books, 2010, p. 9. ISBN 9780345507983
  8. ↑ "Deciphering Developmental Disorders (DDD) project". www.ddduk.org. Wellcome Trust Sanger Institute. Retrieved 2017-01-27.
  9. ↑ McRae, Jeremy F.; Clayton, Stephen; Fitzgerald, Tomas W.; Kaplanis, Joanna; Prigmore, Elena; Rajan, Diana; Sifrim, Alejandro; Aitken, Stuart; Akawi, Nadia (2017). "Prevalence and architecture of de novo mutations in developmental disorders". Nature. 542: 433–438. doi:10.1038/nature21062.
  10. ↑ Walsh, Fergus (2017-01-25). "Child gene study identifies new developmental disorders". BBC News. Retrieved 2017-01-27.
  11. ↑ "Hunting for Autism's Earliest Clues". Autism Speaks. 18 September 2013.
  12. 1 2 3 4 Dereu, Mieke. (2010). Screening for Autism Spectrum Disorders in Flemish Day-Care Centers with the Checklist for Early Signs of Developmental Disorders. Springer Science+Business Media. 1247-1258.
  13. ↑ Gotts S. J., Simmons W. K., Milbury L. A., Wallace G. L., Cox R. W., Martin A.. Fractionation of social brain circuits in autism spectrum disorders. Brain. 2012;135(9):2711-2725. doi:10.1093/brain/aws160. PMID 22791801.
  14. ↑ Subbaraju V, Sundaram S, Narasimhan S. Identification of lateralized compensatory neural activities within the social brain due to autism spectrum disorder in adolescent males. European Journal of Neuroscience. 2017. doi:10.1111/ejn.13634.
  15. 1 2 Tresco, Katy E. (2004). Attention Deficit Disorders: School-Based Interventions. Pennsylvania: Bethlehem.
  16. ↑ C. W. Popper (1997). "Antidepressants in the treatment of attention-deficit/hyperactivity disorder". The Journal of Clinical Psychiatry. 58 Suppl 14: 14–29. PMID 9418743.
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