NERO DEVELOPMENTAL DISORDER NOTES

1. Attention-Deficit/Hyperactivity Disorder (ADHD)

o Symptoms: Inattention, hyperactivity, impulsivity.
o Subtypes: Inattentive type, Hyperactive-Impulsive type, combined type.
o Impacts: Academic challenges, disorganization, impulsive behavior, social
difficulties.
2. Autism Spectrum Disorder (ASD)
o Symptoms: Difficulty with social interaction, communication challenges,
restricted/repetitive behaviors.
o Severity: Varies widely, ranging from mild (high-functioning) to severe
(requiring significant support).
o Impacts: Sensory sensitivities, difficulty with change, strong focus on specific
interests.
3. Learning Disabilities
o Types: Dyslexia (reading), Dyscalculia (math), Dysgraphia (writing).
o Symptoms: Difficulty in specific academic areas despite normal intelligence.
o Impacts: Poor academic performance, frustration, avoidance of challenging tasks.
4. Intellectual Disability (ID)
o Symptoms: Below-average intellectual functioning, deficits in adaptive behaviors
(communication, daily living skills).
o Severity: Mild to profound.
o Impacts: Requires varying levels of support in education, daily tasks, and
decision-making.
5. Developmental Coordination Disorder (DCD)
o Symptoms: Poor motor coordination, clumsiness, difficulty with fine/gross motor
tasks.
o Impacts: Delays in motor skills, difficulty with handwriting, sports, and daily
tasks requiring motor control.
6. Speech and Language Disorders
o Types: Expressive/receptive language disorders, stuttering, phonological
disorders.
o Symptoms: Difficulty with language expression, comprehension, or speech
production.
o Impacts: Communication barriers, social interaction challenges.

Each disorder typically begins in early childhood and can affect academic, social, and
occupational functioning.
Here’s a detailed study note on Attention-Deficit/Hyperactivity Disorder (ADHD):

1. Definition

ADHD is a neurodevelopmental disorder characterized by persistent patterns of inattention,

hyperactivity, and impulsivity that interfere with functioning or development.

2. Core Symptoms

ADHD presents in three main types based on the predominant symptom profile:

A. Inattentive Type

 Difficulty sustaining attention.

 Easily distracted by external stimuli or own thoughts.
 Frequently loses things necessary for tasks (e.g., schoolwork, keys).
 Often forgetful in daily activities.
 Fails to follow through on instructions or finish tasks.
 Avoids or dislikes tasks requiring sustained mental effort (e.g., homework).
 Poor organizational skills.

B. Hyperactive-Impulsive Type

 Fidgeting or tapping hands/feet; difficulty remaining seated.

 Excessive talking or interrupting others.
 Difficulty waiting for a turn.
 Blurting out answers before questions are completed.
 Running or climbing in inappropriate situations.
 Inability to engage in quiet activities.
 Restlessness, often described as “on the go” or “driven by a motor.”

C. Combined Type

 Features of both inattention and hyperactivity/impulsivity are present.

 This is the most common type diagnosed.

3. Diagnostic Criteria (DSM-5)

 Duration: Symptoms must be present for at least 6 months.

 Age of Onset: Symptoms must appear before age 12.
 Setting: Symptoms must be observed in at least two settings (e.g., home, school, work).
 Impact: Significant impairment in social, academic, or occupational functioning.
 Exclusions: Symptoms should not be better explained by another mental disorder (e.g.,
anxiety, mood disorder).
4. Prevalence and Onset

 ADHD affects about 5% of children and 2.5% of adults globally.

 Boys are more frequently diagnosed than girls, especially in childhood.
 Symptoms often become apparent in early childhood, especially in school settings where
demands for attention and self-regulation increase.

5. Causes and Risk Factors

 Genetics: ADHD has a strong hereditary component, with studies indicating a 70-80%
heritability rate.
 Brain Structure: Differences in the size and activity of certain brain regions (e.g.,
prefrontal cortex, basal ganglia) involved in attention and impulse control.
 Neurotransmitters: Dysregulation of dopamine and norepinephrine pathways, which
play roles in attention and reward processing.
 Environmental Factors: Prenatal exposure to smoking, alcohol, or lead; premature birth
or low birth weight; early trauma or stress.

6. Executive Functioning Deficits

Individuals with ADHD often struggle with executive functions, which include:

 Working memory: Difficulty holding and manipulating information.

 Planning and organizing: Challenges in setting goals and following steps.
 Inhibitory control: Difficulty controlling impulses and resisting distractions.
 Time management: Poor awareness of time, leading to procrastination and missed
deadlines.
 Emotional regulation: Difficulty managing frustration, anger, or stress.

7. Comorbidities

ADHD often occurs alongside other conditions:

 Oppositional Defiant Disorder (ODD): Frequent temper outbursts, defiance, and

hostility.
 Conduct Disorder: More severe behavioral issues, including aggression and rule-
breaking.
 Anxiety Disorders: Excessive worry and fear, leading to physical symptoms and
avoidance.
 Depression: Feelings of sadness, hopelessness, and loss of interest in activities.
 Learning Disabilities: Difficulties with reading, writing, or math.
 Substance Use Disorders: Increased risk for smoking, alcohol, or drug use in
adolescence and adulthood.
8. Impact on Daily Life

 Academic Performance: Poor attention and focus can lead to incomplete assignments,
failing grades, and difficulty with exams.
 Social Relationships: Impulsivity may result in interrupting others or difficulty
following social cues, leading to conflicts and rejection by peers.
 Family Life: Parents may experience stress due to their child’s disorganization, lack of
follow-through, or oppositional behavior.
 Occupational Difficulties: Adults with ADHD may struggle to keep up with work
demands, meet deadlines, or stay organized.

9. Assessment and Diagnosis

 Behavioral Observations: Teachers, parents, and other caregivers provide feedback

through standardized rating scales (e.g., Conners’ Rating Scales, Vanderbilt Assessment
Scales).
 Clinical Interviews: Comprehensive interview with parents, teachers, and the
child/adult.
 Neuropsychological Testing: Helps assess cognitive function and rule out other potential
causes of symptoms.

10. Treatment Options

 Medications: Stimulant medications (e.g., methylphenidate, amphetamines) are the most

common treatment. Non-stimulant options (e.g., atomoxetine, guanfacine) are also used.
o Stimulants: Increase dopamine and norepinephrine levels, improving attention
and reducing hyperactivity.
o Non-Stimulants: Useful for those who don’t respond well to stimulants or have
side effects.
 Behavioral Therapy: Focuses on improving organization, time management, impulse
control, and social skills.
o Parent Training: Teaches parents strategies for managing ADHD behaviors at
home (e.g., reinforcement, setting structure).
o School Interventions: Individualized Education Plans (IEPs), 504 plans, or
classroom accommodations (e.g., seating arrangements, extended time on tests).
 Cognitive-Behavioral Therapy (CBT): Helps individuals develop coping mechanisms
for managing distractibility, procrastination, and impulsivity.
 Lifestyle Changes: Physical activity, healthy diet, and sleep hygiene can support
symptom management.
 Coaching: ADHD coaches help with organization, planning, and goal-setting.
11. Prognosis

 Children: Symptoms may improve with age, but 50-60% of children continue to
experience symptoms into adulthood.
 Adults: Many adults develop coping strategies, but challenges with attention,
organization, and impulsivity can persist, affecting career and relationships.

12. Research and Future Directions

 Genetic Studies: Ongoing research into specific genes associated with ADHD.
 Neuroimaging: Advances in brain imaging to better understand ADHD’s neurological
basis.
 Alternative Therapies: Exploring non-pharmacological treatments like neuro feedback
and mindfulness-based therapies.

The 4P Model in clinical psychology provides a framework for understanding mental health
conditions by categorizing factors into four domains: Predisposing, Precipitating,
Perpetuating, and Protective. Here’s how the model applies to
Attention-Deficit/Hyperactivity Disorder (ADHD):

1. Predisposing Factors (Underlying vulnerabilities)

 Genetics: A strong hereditary component, with ADHD running in families. Children with
parents or siblings who have ADHD are at higher risk.
 Brain Structure and Function: Differences in brain regions associated with attention,
impulse control, and executive functions (e.g., smaller prefrontal cortex, lower dopamine
activity).
 Prenatal Factors: Maternal smoking, alcohol use, or exposure to toxins during
pregnancy, as well as premature birth and low birth weight.
 Temperament: Children with higher levels of baseline activity or impulsivity may be
more prone to ADHD.

2. Precipitating Factors (Triggers for the onset of symptoms)

 Environmental Stressors: Stressful events such as changes in family structure (e.g.,

divorce, moving homes) or school transitions can exacerbate or bring about symptoms.
 Early Childhood Trauma: Exposure to trauma, abuse, or neglect during early
development may contribute to the onset of ADHD symptoms.
 Academic Demands: Increased cognitive and attention demands when starting school
may make ADHD symptoms more noticeable.
 Diet and Sleep Issues: Poor nutrition, irregular sleep patterns, or insufficient sleep can
trigger or worsen ADHD-related behaviors.
3. Perpetuating Factors (Maintaining or prolonging the condition)

 Negative Family Dynamics: Inconsistent discipline, high parental stress, or family

conflict can reinforce ADHD symptoms, worsening behavioral issues.
 Academic Failure: Difficulty keeping up with schoolwork and negative feedback from
teachers can lead to reduced self-esteem and disengagement, perpetuating attention
problems.
 Peer Rejection: Difficulty maintaining friendships due to impulsivity or hyperactivity
can lead to social isolation, further affecting behavior.
 Cognitive Challenges: Executive function deficits (e.g., disorganization, poor time
management) create ongoing difficulties in managing responsibilities, maintaining focus,
and controlling impulses.
 Lack of Treatment: Untreated or inadequately managed ADHD, such as lack of
behavioral interventions or medication, can prolong symptoms and their impact.

4. Protective Factors (Buffers or supports)

 Supportive Family Environment: Consistent structure, clear expectations, and positive

reinforcement at home can improve behavior.
 Effective Treatment: Early intervention with behavioral therapies, medication, and
accommodations in school can help manage symptoms.
 High Intelligence or Strong Skills: Some individuals with ADHD may have specific
strengths (e.g., creativity, problem-solving) that help them compensate for their
challenges.
 Strong Social Support: Positive relationships with friends, teachers, or mentors can help
mitigate social and academic struggles.
 Adaptive Coping Skills: Developing strategies for organization, time management, and
emotional regulation can reduce the negative impact of ADHD symptoms.

This 4P model helps identify a range of factors influencing ADHD and provides a structured
approach to understanding the disorder's development, maintenance, and potential interventions.

Case: Sam, 12-year-old male, diagnosed with ADHD – Combined type

1. Predisposing Factors (Underlying vulnerabilities)

 Genetics: Sam’s father has a history of ADHD, and his older brother also exhibits
hyperactive and impulsive behaviors. This suggests a hereditary predisposition to ADHD.
 Brain Development: Neuroimaging studies in Sam show under activity in the prefrontal
cortex, which is involved in attention and impulse control, aligning with typical ADHD
neurological patterns.
 Temperament: From a young age, Sam was more active and impulsive than his peers.
He was easily excitable, had difficulty waiting his turn, and showed trouble staying
focused even during play.
  Prenatal History: Sam’s mother experienced high levels of stress during pregnancy, and
Sam was born prematurely, which may have contributed to his neurodevelopmental
vulnerabilities.

2. Precipitating Factors (Triggers for the onset of symptoms)

 School Transition: Sam’s symptoms became more evident when he transitioned from
elementary to middle school, where academic demands increased, and the environment
became less structured. His teachers noted that he struggled to keep up with more
complex assignments, leading to frustration.
 Family Stress: Recently, there has been increased conflict at home due to his parents’
divorce. This emotional upheaval has led to increased acting out, impulsivity, and
challenges with emotional regulation.
 Sleep Issues: Sam has irregular sleep patterns, often staying up late on his devices and
waking up tired, which worsens his attention and hyperactivity during the day.

3. Perpetuating Factors (Maintaining or prolonging the condition)

 Academic Failure: Sam’s academic struggles are ongoing. His disorganization and lack
of focus result in incomplete assignments, poor test performance, and frequent feedback
from teachers about his inability to stay on task. This negative reinforcement lowers his
motivation and self-esteem.
 Family Dynamics: Inconsistent discipline and structure at home, especially post-divorce,
have contributed to Sam’s impulsivity and oppositional behavior. His parents often argue
about how to handle his behavior, leading to inconsistent approaches.
 Social Issues: Sam’s hyperactivity and impulsiveness have made it difficult for him to
form and maintain friendships. He often interrupts conversations and has trouble sharing,
which has led to social rejection, further impacting his self-esteem and emotional well-
being.
 Lack of Formal Support: Although Sam’s ADHD diagnosis was made a year ago, there
has been minimal intervention. He has not yet been placed on medication, and behavioral
therapy has been inconsistent due to his parents’ schedules.

4. Protective Factors (Buffers or supports)

 Intelligence and Creativity: Despite his struggles, Sam is bright and shows strong
creative thinking. He enjoys building and designing things, which could be a strength that
helps him focus when engaged in activities he enjoys.
 Supportive Teachers: Sam has a few teachers who recognize his potential and try to
provide him with additional support, such as breaking down tasks into smaller steps and
offering positive reinforcement when he stays on task.
 Potential for Medication and Behavioral Therapy: If Sam’s parents follow through
with medical treatment (e.g., stimulant medication) and consistent behavioral therapy,
this could greatly improve his attention and impulsivity. Structured interventions such as
an Individualized Education Plan (IEP) at school could also help.
  Close Friend: Sam has one close friend who accepts his quirks and often includes him in
social activities, providing a small but important source of social support.

In this case, Sam’s ADHD symptoms are influenced by a combination of genetic predispositions,
environmental stressors, and inconsistent support, with potential protective factors in place that
could help mitigate the impact of his symptoms.

Case Study: Emily, a 10-year-old girl in 5th grade, diagnosed with ADHD –
Inattentive type.

Background

Emily is a quiet, day dreamy child who has always been described as “smart but distracted.” In
school, she struggles to keep up with her classmates. Her teacher reports that Emily often misses
assignments and forgets instructions, but she doesn’t cause disruptions in class. At home, Emily
has trouble following through on chores, often forgets things, and gets distracted easily. Socially,
she has a few close friends but is sometimes left out because she’s slow to respond in
conversations and activities.

1. Predisposing Factors (Underlying vulnerabilities)

 Family History: Emily’s mother has mild symptoms of ADHD and reports struggling
with organization and inattention during her childhood. This genetic link increases
Emily’s likelihood of having ADHD.
 Temperament: Since early childhood, Emily has shown signs of being easily distracted
and daydreamy, often seeming “lost in her own world.”
 Early Development: Emily was slow to develop certain motor skills, and she had a slight
delay in speech, which may indicate early signs of neurodevelopmental issues.

2. Precipitating Factors (Triggers for the onset of symptoms)

 Increased Academic Demands: As Emily transitioned to 5th grade, the complexity of

tasks and the need for more independent work increased. Her struggles with organization
and attention became more apparent when the workload required more focus and time
management.
 Change in Teacher: Emily’s previous teacher provided a lot of structure, which helped
her stay on task. However, her current teacher has a less structured classroom approach,
which has led to a worsening of Emily’s inattention and organizational problems.
 Peer Issues: Recently, Emily’s friends have begun to exclude her during group activities
because she often doesn’t keep up with the conversation or misses social cues. This
change in her social environment has caused emotional stress, worsening her ability to
focus.
3. Perpetuating Factors (Maintaining or prolonging the condition)

 Academic Struggles: Emily’s ongoing academic difficulties perpetuate her feelings of

failure and frustration. Her disorganization and missed assignments lead to poor grades,
reinforcing her disengagement from schoolwork.
 Low Self-Esteem: As Emily struggles more with schoolwork and social interactions, her
self-esteem has declined. She feels less competent than her peers, which perpetuates her
avoidance of tasks that require focus and attention.
 Family Stress: At home, Emily’s parents have different approaches to managing her
inattention. Her mother tends to be lenient, while her father is more strict. This
inconsistency in handling her behaviors leads to continued disorganization and
procrastination.
 Lack of Diagnosis and Support: Although Emily’s teacher and parents recognize her
struggles, she has not yet received formal support or accommodations at school, which
perpetuates her difficulties in managing her tasks and staying organized.

4. Protective Factors (Buffers or supports)

 Cognitive Strengths: Despite her difficulties, Emily is intelligent and shows a strong
interest in reading and creative writing. When engaged in these activities, she can focus
for longer periods, which could be leveraged to help her develop attention and task
completion skills.
 Parental Support: Emily’s parents are involved in her education and are committed to
helping her succeed. They are actively seeking ways to support her and are considering
formal evaluation for ADHD.
 Supportive Teacher: While her current classroom lacks structure, Emily’s teacher is
understanding of her difficulties and has started to implement strategies like giving Emily
checklists and extra time on assignments.
 Close Friend: Emily has one best friend who understands her and accepts her as she is.
This friend provides emotional support and helps buffer some of the social rejection
Emily faces from others.

Application of the 4P Model to Emily’s ADHD Case

Predisposing Factors (Why Emily is vulnerable to ADHD)

 Family history of ADHD (genetics).

 Inherent temperamental traits such as being easily distracted and daydreamy from a
young age.
 Slight developmental delays (speech, motor skills), indicating early neurodevelopmental
vulnerabilities.
 Precipitating Factors (What triggered or worsened the condition)

 Increased academic demands in 5th grade, requiring more focus, organization, and
independence.
 Change in teacher and classroom structure, leading to reduced external support for
organization.
 Social stress due to exclusion by peers, affecting her focus and emotional well-being.

Perpetuating Factors (What is keeping the condition going)

 Ongoing academic struggles due to missed assignments and disorganization, reinforcing

her disengagement from school.
 Declining self-esteem from both academic failure and social exclusion, leading to further
withdrawal.
 Inconsistent parental approaches to managing her behaviors at home, causing

Case Study: James, a 6-year-old boy in 1st grade, diagnosed with ASD.

Background

James is a quiet, introverted child who tends to avoid social interactions with his peers. His
parents noticed signs of delayed speech development when he was around 2 years old, and by the
time he entered preschool, it was clear that he had difficulties in communication, eye contact,
and play. James is highly focused on specific interests, such as dinosaurs, and can spend hours
talking about them. He has difficulties understanding social cues, often prefers playing alone,
and becomes distressed by changes in his routine.

1. Predisposing Factors (Underlying vulnerabilities)

 Genetic Factors: There is a family history of neurodevelopmental disorders. James's

maternal cousin has been diagnosed with ASD, suggesting a potential genetic
predisposition.
 Early Developmental Delays: James exhibited delayed speech milestones, first speaking
simple words at 3 years old. His parents also noticed a lack of joint attention, such as
pointing or responding to his name during early childhood.
 Temperament: As a baby, James was often unresponsive to social engagement, showed
little interest in other children, and seemed content playing alone.

2. Precipitating Factors (Triggers for the onset of symptoms)

 Preschool Challenges: James’s symptoms became more evident when he started

preschool. The social demands of interacting with other children highlighted his
difficulties in communication and understanding social cues.
 Changes in Routine: A recent move to a new house led to increased behavioral issues.
James became more rigid in his routines, refusing to eat unfamiliar foods or follow new
daily routines, showing more repetitive behaviors.
  Sensory Sensitivities: During kindergarten, James became extremely distressed by loud
noises, such as school bells or assemblies, which increased his social withdrawal.

3. Perpetuating Factors (Maintaining or prolonging the condition)

 Social Isolation: James’s difficulty in forming friendships has led to increased isolation
at school. His lack of social interaction limits his opportunities to develop social skills,
perpetuating his difficulty in understanding social cues and norms.
 Parental Overprotection: Due to James’s meltdowns and sensitivities, his parents often
avoid new activities or situations that might cause distress. This limits his exposure to
social environments and opportunities for adaptation.
 Inflexibility with Routines: James’s reliance on rigid routines makes it difficult for him
to adjust to the unpredictability of school or new experiences. Any change in schedule
increases his anxiety, which perpetuates his need for sameness.
 Lack of Formal Social Skills Intervention: Although James’s school recognizes his
difficulties, there have been limited efforts to implement formal social skills training or
an Individualized Education Plan (IEP) tailored to his needs.

4. Protective Factors (Buffers or supports)

 Supportive Family: James’s parents are highly involved in his care and have been
advocating for him to receive more tailored support at school. They ensure he follows
structured routines at home, which provides a sense of stability.
 Cognitive Strengths: James has a strong interest in dinosaurs and can recall extensive
information about them, demonstrating strong memory and intellectual potential. This
interest can be used as a tool to engage him in learning and social situations.
 School Awareness: James’s teachers are aware of his diagnosis and are starting to make
small accommodations, such as giving him a quiet space during overwhelming sensory
experiences.
 Speech Therapy: James has been attending speech therapy to improve his
communication skills, which has resulted in gradual improvements in his ability to
express his needs.

Application of the 4P Model to James’s ASD Case

Predisposing Factors (Why James is vulnerable to ASD)

 Family history of neurodevelopmental disorders: Genetic link with a cousin diagnosed

with ASD.
 Developmental delays in speech and social milestones, such as lack of joint attention
and unresponsiveness to his name.
 Temperamental traits: Preferring solitary play, minimal interest in social engagement
from an early age.

Precipitating Factors (What triggered or worsened the condition)

  School environment: Social demands in preschool highlighted James’s difficulties with
communication and social interaction.
 Changes in routine: A move to a new house led to increased rigidity and anxiety,
causing more repetitive behaviors and distress.
 Sensory overload: Sensitivities to loud noises in school settings (e.g., bells, assemblies)
have contributed to his withdrawal and heightened social difficulties.

Perpetuating Factors (What is keeping the condition going)

 Social isolation: Limited interactions with peers at school, reinforcing his lack of social
skill development.
 Parental avoidance of new experiences: To avoid James’s meltdowns, his parents limit
a new situation, which perpetuates his inability to adapt and cope with change.
 Rigid routines: His need for routine and distress from changes perpetuates his
inflexibility and resistance to new experiences.
 Lack of formal intervention: Absence of a structured social skills program or an
Individualized Education Plan (IEP) designed to support his specific needs in school.

Protective Factors (What can help manage or reduce the impact)

 Supportive family: Parents are dedicated to advocating for his needs at school and
maintaining a structured, stable home environment.
 Cognitive strengths: His intense interest in dinosaurs can be used as a strength to engage
him in academic tasks and social activities.
 School awareness and minor accommodations: Teachers are starting to recognize his
needs and provide accommodations like quiet spaces for sensory overload.
 Speech therapy: Ongoing therapy helps improve his communication skills, which is
slowly improving his ability to express himself.

This case of James illustrates how ASD manifests and is maintained by various factors while
highlighting potential protective supports that can be leveraged to help him thrive.

Autism Spectrum Disorder (ASD): Detailed Study Notes

1. Definition

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized

by persistent challenges in social communication, social interaction, and restricted, repetitive
patterns of behavior, interests, or activities. The term "spectrum" reflects the wide variability in
challenges and strengths possessed by each individual with autism.

2. Core Symptoms

ASD is primarily defined by two areas of difficulty:

A. Social Communication and Interaction

 Challenges in Social Reciprocity: Difficulty with back-and-forth conversation,

understanding and responding to social cues, or maintaining relationships.
 Non-verbal Communication Difficulties: Trouble with understanding or using body
language, facial expressions, eye contact, and gestures.
 Developing and Maintaining Relationships: Difficulty with making and keeping
friends, understanding social norms, or engaging in imaginative play.

B. Restricted and Repetitive Behaviors

 Repetitive Movements or Speech: Examples include hand-flapping, rocking, repeating

certain words or phrases (echolalia).
 Inflexibility in Routines: A need for routine or ritualized patterns of behavior. Even
small changes in schedule or environment can cause distress.
 Fixated Interests: Intense focus on specific topics or objects, such as dinosaurs, trains,
numbers, or maps.
 Sensory Sensitivities: Hyper- or hypo-sensitivity to sensory stimuli such as light, sound,
textures, or temperature (e.g., distress at loud noises, refusal to wear certain fabrics).

3. Diagnostic Criteria (DSM-5)

According to the DSM-5, the diagnostic criteria for ASD include:

 Persistent deficits in social communication and social interaction across multiple

contexts.
 Restricted, repetitive patterns of behavior, interests, or activities.
 Symptoms present in the early developmental period but may not fully manifest until
social demands exceed capabilities.
 Symptoms cause significant impairment in social, occupational, or other important
areas of functioning.
 Symptoms are not better explained by intellectual disability or global developmental
delay.


4. Early Signs and Symptoms

Infants and Toddlers

 Lack of eye contact or inconsistent use of eye contact.

 Failure to respond to their name.
 Limited pointing or showing objects to share interest.
 Delayed speech or unusual speech patterns (e.g., echolalia).
 Lack of interest in playing with others or engaging in interactive play.
  Repetitive movements such as rocking or flapping.
 Sensitivity to sensory stimuli (e.g., textures, lights, sounds).

School-Aged Children

 Difficulty understanding social rules or taking turns in conversations.

 Limited use of gestures and facial expressions to communicate.
 Difficulty with peer relationships and playing cooperatively with others.
 Rigid adherence to specific routines.
 Intense focus on specific subjects (e.g., memorizing facts about trains or animals).
 Unusual responses to sensory stimuli, such as becoming overwhelmed by noise or
seeking sensory input through spinning or touching objects.

5. Subtypes and Severity Levels (DSM-5)

ASD is now diagnosed based on severity levels to reflect the degree of support required:

 Level 1: Requiring Support: Individuals can communicate but may struggle with social
interactions or adapting to changes in routine.
 Level 2: Requiring Substantial Support: More significant challenges with social
communication, limited speech, and marked inflexibility in behavior.
 Level 3: Requiring Very Substantial Support: Severe deficits in social communication,
minimal to no speech, extreme difficulty coping with changes, and highly repetitive
behaviors.

6. Causes of ASD

ASD is believed to arise from a complex interaction of genetic and environmental factors:

 Genetic Factors: There is strong evidence of a genetic predisposition to ASD. Studies

show a higher risk of ASD in families with one or more members diagnosed with the
disorder. Certain gene mutations have been identified in some individuals with ASD.
 Environmental Factors: These include prenatal influences such as maternal infection,
medication use during pregnancy, or environmental toxins. Advanced parental age has
also been suggested as a risk factor.
 Neurological Differences: Brain imaging studies have shown differences in brain
structure and function in individuals with ASD, particularly in areas related to social
communication and sensory processing.

7. Comorbidities
ASD often occurs alongside other medical or psychiatric conditions:

 Intellectual Disability: Approximately 30-40% of individuals with ASD have co-

occurring intellectual disability.
 ADHD (Attention-Deficit/Hyperactivity Disorder): Difficulty with attention and
hyperactivity is common in individuals with ASD.
 Anxiety Disorders: Many children and adults with ASD experience high levels of
anxiety, particularly in unfamiliar or overwhelming social settings.
 Sensory Processing Disorder: Atypical responses to sensory input (e.g., heightened
sensitivity to sound, touch, light) are frequently observed.
 Epilepsy: Seizure disorders occur more commonly in individuals with ASD.
 Sleep Disorders: Difficulties with falling asleep, staying asleep, or waking up frequently
during the night are common.
 Gastrointestinal Issues: Problems like constipation or food intolerances are also
frequently reported.

8. Treatment and Management

Although there is no cure for ASD, early intervention and tailored treatments can significantly
improve quality of life. Treatment approaches are typically multimodal and include:

A. Behavioral Therapies

 Applied Behavior Analysis (ABA): A widely used, evidence-based approach that uses
positive reinforcement to improve communication, social skills, and adaptive behaviors.
 Early Start Denver Model (ESDM): An early intervention program for toddlers with
ASD that focuses on social, emotional, and cognitive skills.
 Social Skills Training: Helps individuals learn and practice appropriate social behaviors,
such as taking turns, recognizing social cues, and initiating conversations.

B. Speech and Language Therapy

 Improves communication skills, including language development, understanding non-

verbal cues, and learning alternative forms of communication (e.g., Picture Exchange
Communication System – PECS, or sign language).

C. Occupational Therapy

 Focuses on improving daily living skills, fine motor skills, and addressing sensory
integration difficulties.

D. Medication
  While no medication specifically treats ASD, medications may be prescribed to manage
symptoms like anxiety, hyperactivity, or aggression. Commonly used medications
include selective serotonin reuptake inhibitors (SSRIs) for anxiety or antipsychotics for
irritability (e.g., Risperidone).

E. Educational Interventions

 Individualized Education Programs (IEPs): Special education plans that provide

specific accommodations and support in the classroom, tailored to the child’s needs.
 Classroom Modifications: Sensory-friendly environments, use of visual schedules, and
providing structure and routine help ASD students thrive in school settings.

9. Prognosis

 The prognosis for individuals with ASD varies widely based on factors such as the
severity of the condition, presence of comorbidities, and the timing and intensity of
interventions.
 Early intervention and support can lead to significant improvements in communication,
social skills, and adaptive functioning, allowing many individuals to lead fulfilling lives.
 Individuals with high-functioning ASD (previously Asperger’s Syndrome) may grow to
be independent adults, although social challenges may persist.

10. Recent Trends in ASD Research

 Genetics: Ongoing research aims to identify specific genes associated with ASD to better
understand its causes and potential treatment targets.
 Neurodiversity Movement: Increasing advocacy for the acceptance of ASD as a
variation in human development rather than a disorder to be "cured."
 Technological Interventions: Use of apps, robots, and virtual reality in improving social
skills and communication in children with ASD.
 Precision Medicine: Tailoring interventions based on individual genetic, behavioral, and
environmental profiles to improve treatment outcomes.