Neurodevelopmental Disorders
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define and identify common neurodevelopmental disorders in children.
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Recognize clinical features and screening tools for ADHD, ASD, and Cerebral Palsy.
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Understand supportive, pharmacological, and multidisciplinary management approaches.
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Identify complications and referral criteria for specialized care.
Attention Deficit Hyperactivity Disorder (ADHD)
Description:
ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity lasting ≥6 months, negatively affecting social, academic, or occupational functioning.
Clinical Features:
| Domain | Signs & Symptoms |
|---|---|
| Inattentiveness | Short attention span, easily distracted, difficulty listening, following instructions, organizing tasks, forgetfulness, avoidance of sustained mental effort |
| Hyperactivity / Impulsivity | Excess motor activity, running, fidgeting, rapid speech, inability to remain seated, blurting answers, difficulty waiting, interrupting others |
Investigations:
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DSM-5 criteria
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Vanderbilt Teacher Rating Scale
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Symptoms present >6 months in ≥1 setting (home and school)
Treatment:
| Type | Intervention |
|---|---|
| Supportive | Behavioral parent therapy, CBT, environment restructuring, classroom management, family therapy, play therapy, exercise, social skills training |
| Pharmacological | Methylphenidate 5–20 mg 12-hourly (long-acting), short-acting 8-hourly, max 60 mg/day; Dextroamphetamine 10–60 mg 12-hourly |
Note: If stimulants are unavailable or ineffective, other psychotropics may be used under specialist guidance. Refer to paediatrician/neurologist.
Autism Spectrum Disorder (ASD)
Description:
ASD is a neurodevelopmental disorder with deficits in social communication and interaction and restricted, repetitive behaviors.
Screening Tools:
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M-CHAT (16–30 months)
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DSM-5 criteria
Clinical Features:
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Lack of social interaction, delayed language, poor eye contact, repetitive behaviors (echolalia, hand-flapping), distress with minor changes, obsessive interests, unusual sensory reactions.
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Developmental milestones: e.g., no pointing by 14 months, no pretend play by 18 months.
Treatment:
| Type | Intervention |
|---|---|
| Supportive | Social skills interventions, family therapy, occupational therapy, early education, behavior modification, screen for comorbidities (ADHD, mood/anxiety) |
| Pharmacological | For irritability/self-injurious behavior: Risperidone 0.01 mg/kg/day starting, maintenance 0.02–0.04 mg/kg/day (ages 5–12, <50 kg) |
Referral:
Refer patients not responding to risperidone to psychiatrist, neurologist, or appropriate sub-specialist.
Cerebral Palsy (CP)
Description:
CP comprises non-progressive movement and posture disorders due to early brain injury, often associated with sensory, cognitive, and behavioral abnormalities.
Risk Factors:
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Prematurity, SGA, multiple pregnancy, HIE, neonatal meningitis/sepsis
Types of CP:
| Type | Characteristics |
|---|---|
| Spastic | Diplegia, hemiplegia, quadriplegia |
| Dyskinetic | Dystonic, athetoid |
| Ataxic | Ataxia |
| Global involvement | Mixed features |
Treatment:
| Type | Intervention |
|---|---|
| Medication | Baclofen for spasticity, Levodopa for dystonia |
| Multidisciplinary | Physiotherapy, occupational therapy, speech therapy, orthopaedics, family/caregiver support |
| Functional Assessment | GMFCS (Gross Motor Function Classification System) |
Complications:
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Neurological: epilepsy, hydrocephalus, sensory deficits
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Behavioral / Learning: sleep disturbance, depression, autistic features, learning difficulties
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Gastrointestinal: dysphagia, reflux, constipation
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Bone / Orthopaedic: osteoporosis, scoliosis, hip dislocation, fractures
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Respiratory: aspiration, chest infections
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Skin: drooling, pressure sores
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Dental: poor hygiene, caries
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Genito-urinary: neurogenic bladder