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Developmental disorders in children .pptx
- 2. Development Characterised by processes in which each individual uniquely adapts and integrates his or her own nature with the opportunities and limitations of his or her experience across time
- 3. Definition of Child Development • Development is a series of coordinated, progressive changes occurring from conception to till the end Or • Is a series of qualitative, progressive, and coherent changes that indicate the maturation of the individual Or • Average or “on-time” growth based on the attainment of specific physical, cognitive, linguistic, social-emotional, and behavioral milestones across specific stages.
- 4. Principles of Development Principles Implications for clinical assessment Continuous Are there any arrested or incomplete or delayed or deviant behaviours? Predictable Given a current skill, what is the next skill? Product of maturation and learning Family history of developmental problems Genetic disorders (3-Generation genogram) Stimulating environment Maternal sensitivity Socio-ecological agencies Each stage characterized by specific tasks Are the tasks adequate? Pre-requisites are there? Follows specific principles: Cephalo-caudal law Proximo-distal law If higher items are passed, lower items are passed (exceptions- CP/Pure neurological or sensory-motor conditions) Universal yet individualistic Norms are not necessarily the ‘norm’ Individual variations are possible Different areas are inter related If one area is affected, assess related areas
- 7. Developmental Transactional Ecological Model (Bronfenbrenner, 1979; Sameroff, 2000) Child’s behaviour at any point in time is a product of reciprocal transactions among the • child’s characteristics (genetic/biological/physical; cognitive/linguistic and socio- emotional competencies) • and the caregiving environment (dynamic interrelationships among child behaviour, caregiver responses to such behaviour and the dyadic relationship) and the • broader ecological context (multiple levels of social organisation, including family, neighbourhood and child care)
- 8. Piaget’s Cognitive Development Theory
- 10. Attachment
- 14. Domains of Nurturing Care for children to reach their Developmental Potential (Lancet, 2016) Domains of Nurturing care Health Nutrition Responsive Caregiving Safety and Security Early Learning
- 15. Play • Contributes to cognitive and social skills • Improves memory, sustained attention, logical reasoning, language, imagination, creativity, understanding of emotions, the ability to reflect on one’s own thinking and taking the perspective of another (Bergen and Mauer, 2000) How to enhance play? • Provide safe space • Encourage without controlling it • Offer both realistic and materials with no clear purpose • Ensure children have rich real world experiences • Help solve social conflicts constructively
- 16. Delays and Disorders Any deviation (e.g. ASD) or delay (e.g. IDD) in the typical development expected of age in a given socio-cultural context is called developmental disorder They delay or impair physical, cognitive, and/or psychological development of children. Types Global Vs. Specific Permanent Vs. Transient
- 17. Classification of neurodevelopmental disorders – DSM-5 or ICD-11 • Key features Onset that is invariably during infancy or childhood Impairment or delay in the development of functions that are strongly related to the biological maturation of the CNS Steady course that not involve remissions or relapses Impairments tend to lessen as children grow older, but deficits may continue into adult life
- 18. Other features of neurodevelopmental disorders Impairment in a development- based skill Impairment in functioning Deviant functioning
- 19. Contd… • Multi-factorial in origin • Tend to improve with age but may be associated with disordered functioning that extends into adulthood • Marked male preponderance • Neuropsychological deficits of various kinds • Comorbidity with other neurodevelopmental disorders is high
- 20. Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) (Gillberg 2010) Draw attention to the symptomatic, genetic, neuropsychological, neurophysiological and developmental overlap among these conditions
- 21. According to DSM-5 Intellectual Disability/ Intellectual Developmental Disorder Communication Disorders Autism Spectrum Disorders Attention-Deficit/Hyperactivity Disorder Specific Learning Disorder Motor Disorders Other neurodevelopmental disorders
- 22. Intellectual Disability • Deficits in intellectual and adaptive functioning in conceptual, social and practical domains • Severity levels – Mild, Moderate, Severe, Profound • Global Developmental Delay • Unspecified Intellectual Disability
- 23. Communication Disorders Language Disorder Speech Sound Disorder Childhood-onset Fluency Disorder (Stuttering) Social (Pragmatic) Communication Disorder
- 24. Autism Spectrum Disorder A. Persistent difficulties in social communication and social interaction across multiple contexts B. Restricted, repetitive patterns of behaviour, interests, or activities Severity levels: Level 1, 2,3 Specifiers With or without accompanying intellectual impairment With or without underlying language impairment Associated with a known medical or genetic condition or environmental factor Associated with another neurodevelopmental, mental or behavioural disorder With catatonia
- 25. Attention-Deficit/Hyperactivity Disorder • Inattention and/or hyperactivity-impulsivity that interferes with functioning or development • Prior to the age of 12 years • Two or more settings • Symptoms interfere with the quality of social, academic or occupational functioning • Specifiers: Combined; Predominantly inattentive; predominantly hyperactive-impulsive presentation • In partial remission • Current severity: Mild; Moderate; Severe
- 26. Specific Learning Disorder Specifiers • With impairment in reading • With impairment in written expression • With impairment in mathematics Level of severity • Mild • Moderate • Severe
- 27. Motor Disorders Stereotypic Movement Disorder Tic Disorders
- 28. Concept of maturational lag • Huge individual differences in the timing of all developmental functions • “Developmental catch-up” • Developmental catch up does not occur in everyone although gains are made with age • Normalisation of cortical thickness over time in children with ADHD who had a good outcome (Shaw et al 2006,2007)
- 29. Explanatory models of concurrent comorbidity (Caron & Rutter, 1991) RISK FACTORS • Genetic • Stochastic • Epigenetic • Early environmental NEURAL & BIOLOGICAL CHARACTERISTICS • Biological processes • Brain structure & function • Neural development • Cognitive impairment PHENOTYPES ID ASD ADHD Communication Disorders SLD Tic disorders
- 30. Epigenetics Answer to the Nature Vs Nurture Debate It’s both!!
- 33. Evidence-based interventions that affect aspects of Nurturing Care (Britto et al 2017)
- 34. Framework to support child development through multi-sectoral approach
- 35. For NDD…
- 36. Assessment • Developmental history • Medical history including prenatal and perinatal history, identification of any past or current health conditions, family history to identify genetic disorders • Physical examination – including those for congenital anomalies, HC, growth evaluation • Individual disorder specific assessments • Other assessments – hearing, vision, cognitive, sensory, motor coordination, psychological including a skill and need based profile
- 38. Management • NDD are lifelong conditions • They almost always improve with time and intervention • Comorbidity is the rule rather than the exception, both with other NDD and with other psychiatric disorders • Need for careful assessment and plan of management • Multidisciplinary inputs • Need regular follow up • Parenting – needs to be addressed both from the parents and the child’s perspective as they are our main resource • Treatment needs to include centre based and community based resources • Treatment including supportive social contexts needs to continue into adulthood
- 39. In conclusion.. • Child development is predictable but complex • A number of interrelated factors have a role • Young children need nurturing care from the start • Multi-sectoral interventions that target multiple risks to development that take care of both the child and the caregiver key with health services as an entry point • Early identification and intervention in NDD is vital • Need long-term support • Multi-disciplinary inputs with multi-sectoral coordination key
- 40. Thank you
Editor's Notes
- Childhood development is a maturational process resulting in an ordered progression of perceptual, motor, cognitive, language, socio-emotional, and selfregulation skills. Thus, the acquisition of skills through the life-cycle builds on the foundational capacities established in early childhood
- Infancy – Obedience/punishment (Avoiding punishment), Preschool – Self-interest (Aiming at reward), School age- Conformity and interpersonal accord and Authority and Social Order(good Boy/Girl and maintaining social order), Teens – Social Contract(Justice and spirit of the Law), Adulthood – Universal principles (Morality is based on principles that transcend mutual benefit)
- Attachment is a specific and circumscribed aspect of the relationship between a parent and a child that is involved in making a child feel safe, secure and protected. Ethological theory of attachment recognizes that the infant’s emotional tie to the caregiver is an evolved response that promotes its survival. Out of the baby’s experiences in the four phases of children construct an enduring affectionate tie that they can use as a secure base in the parents’ absence. The image serves as an internal working model or a set of expectations about the availability of attachment figures, their likleihoof of providing support during times of stress and the self’s interaction with those figures
- A poor start in life can lead to poor health, nutrition, and inadequate learning, resulting in low adult earnings as well as social tensions. Negative consequences impact not only present but also future generations.
- Nurturing care reduces the detrimental effects of disadvantage on brain structure and function which, in turn, improves children’s health, growth, and development Family support and strengthening package - access to quality services (eg, antenatal care, immunisation, nutrition); skills building (eg, nurturing care and reduction of harsh discipline); and support (eg, social protection, safety networks, and family support policies). Caring for the caregiver package - This two-generation package emphasises care and protection of parents’ physical and mental health and wellbeing, while enhancing caregivers’ capacity to provide nurturing care to their child Early learning and protection package - This set of interventions integrates the support of young children with parental support and the facilitation of teachers’ and caregivers’ ability to create a nurturing environment in day care and early childhood centres. The emphasis is on quality and family support through parental empowerment, guidance on nutrition and care, and child protection
- *that tend to be characteristic of many mental disorders.
- Impairment in a development-based skill that is closely related to biological maturation
- Comorbidity – specific disorders of language, learning and motor function
- Having a diagnosis of one of the disorders subsumed under the ESSENCE framework markedly increases the probability of being afflicted with another neurodevelopmental diagnosis
- Intellectual domains – reasoning, problem solving, planning, abstract thinking, judgment, academic learning and learning from experience Adaptive functioning- failure to meet developmental and socio-cultural standards for personal independence and social resposibility
- Deficits in the use of communication for social purposes, change communication to match contexts, rules of communication, understanding idioms, metaphors
- A- deficits in socio-emotional reciprocity, non-verbal communicative behaviours and deficits in developing, maintaining and understanding relationships B-stereotyped, repetitive motor movements, use of objects or speech. Insistence on sameness, inflexible adherence to routine, highly restricted and fixated interests and hypo or hyper responsivity. Level 1: requiring support, level 2: requiring substantial support and level 3: requiring very substantial support
- The acquisition and the execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Manifested as clumsiness, slowness and inaccuracy of performance or motor skills (catching an object, riding a cycle, using scissors, cutlery). Stereotypic movt disorder – repetitive, seemingly driven and apparently purposeless motor behaviour. Specifiers- with or without self-injurious behaviour, associated with a known medical or genetic condition, and levels of severity- mild, moderate and severe. Tic disorders – sudden, rapid, recurrent, non-rhythmic motor movements or vocalisation – Tourette, persistent (chronic) motor or vocal tic disorder, providional tic disorder
- Timing of eruption of teeth, ossification of bones, growth spurt associated with puberty. 87 language impaired children were prospectively followed up and assessed at ages 4, 4.5 and 5.5 years. 2/5ths showed normal language by 5.5 years and 15 years showed no difference in vocabulary and language comprehension skills. But performed less well on tasks of phonological processing and literary skills – suggesting that the catch up was not complete. For those who had language difficulties at age 5.5 years, fell further in their language functioning on follow up. Study done by Bishop and Edmundson 1987. What was the effect of stimulant medication, sex differences, lack of clinical measures in controls, attrition rate. The children in this study also came from socially advantaged backgrounds, had high IQ and no comorbidities
- Stochastic - having a random probability distribution or pattern that may be analysed statistically but may not be predicted precisely. Epigenetic - epigenetics is the study of heritable phenotype changes that do not involve alterations in the DNA sequence. Basically relating to or arising from non-genetic influences on gene expression
- During development, the DNA that makes up our genes accumulates chemical marks that determine how much or how little a gene is expressed. The collection of chemical marks is known as the epigenome. The different experiences children have rearrange those chemical marks
- Family support and strengthening package - access to quality services (eg, antenatal care, immunisation, nutrition); skills building (eg, nurturing care and reduction of harsh discipline); and support (eg, social protection, safety networks, and family support policies). Caring for the caregiver package - This two-generation package emphasises care and protection of parents’ physical and mental health and wellbeing, while enhancing caregivers’ capacity to provide nurturing care to their child Early learning and protection package - This set of interventions integrates the support of young children with parental support and the facilitation of teachers’ and caregivers’ ability to create a nurturing environment in day care and early childhood centres. The emphasis is on quality and family support through parental empowerment, guidance on nutrition and care, and child protection.
- Complex interplay between the child’s biological functioning, psychological adjustment, social context and development. Biological – degree of CNS involvement,. Psy- cognitive appraisal and coping style. Social- greater psychological adjustment of caregivers, use distraction. Developmental- depends on cognitive development