NEURODEVELOPMENTAL DISORDERS

Neurodevelopmental Disorders are a group of conditions that begin in

early childhood. They're marked by developmental deficits that cause
significant impairment in personal, social, academic, or occupational
functioning.
These deficits can be:
Specific: affecting a single area, like language, motor skills, or
communication.
Global: affecting multiple areas, as seen in Intellectual Disabilities.
Categories of Neurodevelopmental Disorders
(I Can Always Ask Some Medical-help)
Intellectual Developmental Disorders (Hani)
Intellectual Developmental Disorder\Intellectual Disability
Characterized by three key features:
1. Deficits in Intellectual Functioning like reasoning, learning, and
problem-solving.
2. Deficits in Adaptive Functioning like independent living,
communication, social participation.
3. Onset During the Developmental Period
Global Developmental Delay
Diagnosed in children under 5 years when developmental milestones are
not met and full testing isn't possible. Used as a temporary diagnosis.

Unspecified Intellectual Developmental Disorder

For individuals over age 5 when assessment is difficult (e.g., due to
blindness, severe illness), and a definitive diagnosis can't be made.

Examples of Intellectual Developmental Disorders

 Down Syndrome:
Extra copy of chromosome 21, leading to intellectual impairment and
distinct physical features.
 Fragile X Syndrome:
Genetic disorder more common in boys, causing learning difficulties and
attention problems.
 Birth Complications:
Lack of oxygen during birth can cause developmental delays or
permanent disability.
Etiology
 Genetic Factors: Down syndrome, Fragile X syndrome.
 Prenatal Factors: Maternal alcohol/drug use, infections (e.g.,
rubella).
 Perinatal Factors: Complications during birth (e.g., oxygen
deprivation).
 Postnatal Factors: Brain injury, infections (e.g., meningitis),
severe malnutrition.
 Environmental Factors: Exposure to toxins (lead) or severe
neglect.

Treatment
Early diagnosis is crucial for better outcomes.
Effective interventions include:
 Therapies like Speech therapy, Occupational therapy.
 Special Education like Tailored programs.
 Family support through counseling/training, and community-
based rehabilitation improve independence and quality of life.

Communication Disorders
Group of Conditions affecting communication, language, and speech
- Cause significant distress and impairment in academic, social, and
daily functioning
- Often appear in early childhood
Language Disorder
Difficulty acquiring and using language (spoken, written, or sign
language) due to reduced vocabulary, sentence structure, or conversation
ability.
Persistent difficulties in:
• Vocabulary
• Sentence structure
• Conversation use
Examples
 A child who says only single words at age 5 instead of sentences.
 Difficulty understanding instructions like “Put the book under the
table.”
 Trouble retelling a simple story in sequence.

Speech Sound Disorder

Problems with articulation (producing sounds correctly) that interfere
with communication.
Difficulty producing speech sounds correctly
Errors affect the clarity & intelligibility of the speech

- Example: Saying 'wabbit' instead of 'rabbit'

Key Features
 Mispronunciation of sounds → e.g., saying “wabbit” instead of
“rabbit”.
 Omission of sounds → e.g., saying “ca” instead of *“cat”*.
 Substitution of sounds→ e.g., “tat” for “cat”*.
 Errors are not age-appropriate
Young children (ages 2–4) naturally make speech mistakes while
learning to talk.
Example: A 3-year-old may say “wabbit”instead of “rabbit” (this is
normal).
But if an older child (e.g., 7 or 8 years old) still makes the same
mistakes, it is not age-appropriate because by that age, children are
expected to pronounce those sounds correctly.

Childhood-Onset Fluency Disorder(Stuttering)

Frequent disruptions in speech flow (repetitions, prolongations,
blocking, etc.) that cause anxiety or limit effective communication.
Problems in fluency & timing
Often worsens with stress/anxiety
Key Features
 Repetition of sounds or syllables→ “b-b-b-ball”
 Prolongation of sounds→ “ssssssun”
 Blocking→ pauses or getting “stuck” before speaking
 Physical signs→ blinking, facial tension, or head nodding while
trying to speak
 Causes distress and difficulty in academic, social, and daily
functioning.
Examples
• A child who repeats the first sound of words frequently.

• A student who avoids speaking in class due to embarrassment.

Social (Pragmatic) Communication Disorder

Difficulty with the social use of verbal and nonverbal communication
(e.g., taking turns, changing speech for listener/context, understanding
implied meanings).
Difficulties in using language socially:
• Taking turns in conversation
• Understanding jokes/idioms
• Matching language to context
Example: Difficulty greeting properly in settings
Key Features
Difficulty following the rules of conversation
 Taking turns while speaking
 Staying on topic
Trouble matching language to context:
 Speaking too formally/informally in the wrong setting
Difficulty understanding nonliteral language:
 Jokes, sarcasm, idioms, metaphors
Problems with social cues:
 Facial expressions, gestures, eye contact
Examples
 A child who talks for too long without letting others respond.
 Not understanding that “It’s raining cats and dogs” means heavy
rain.
 Using the same way of speaking with a teacher and with a close
friend.
 Autism Spectrum Disorder (Esa)
A neurodevelopmental disorder that begins in early childhood.
Significant impairments in:
 Social interaction
• Communication (verbal & non-verbal)
• Repetitive and restricted behaviors

 Children (and adults) with ASD may have:

 Challenges in forming relationships.

 Difficulty understanding social cues (e.g., eye contact, tone of

voice).
 Restricted or repetitive behaviors (e.g., repeating words, lining up
toys).
 Very strong focus on certain interests.
Example: One child may only struggle with social interaction, while
another may be non-verbal and need lifelong support.
Etiology
Genetic factors (family history): Mental or physical conditions that can
be passed down from parents to children through genes.
Neurodevelopmental abnormalities: Problems in how the brain
develops before or after birth.
Environmental factors (prenatal exposure, toxins): Things in the
environment that affect development, especially before birth.
Psychosocial factors (neglect, limited stimulation): Social and
emotional experiences that affect a person’s growth.

Attention Deficit\ Hyperactivity Disorder (Afnan)

Definition (DSM-5-TR):
A persistent pattern of inattention and/or hyperactivity-impulsivity that
interferes with functioning or development.
Core Features:
1. Inattention: fails to give attention to details, forgetful, difficulty
sustaining focus.
2. Hyperactivity: fidgets, unable to stay seated, talks excessively.
3. Impulsivity: blurts out answers, interrupts, can’t wait turn.
Example:
A 9-year-old cannot finish homework, constantly interrupts peers, and
loses belongings.
Subtypes
1. Predominantly Inattentive Type (difficulty sustaining attention).
2. Predominantly Hyperactive Impulsive Type (restless, impulsive).
3. Combined Type (both sets of symptoms).
Development
• Symptoms appear before age 12.
• May continue into adulthood, often with reduced hyperactivity but
persistent inattentiveness.
 Specific Learning Disorder
Persistent difficulties in learning and using academic skills despite
interventions
With impairments in:
 Reading (e.g., dyslexia)
Trouble with word reading accuracy, reading rate/fluency, or
comprehension (includes dyslexia)
 Written expression(dysgraphia)
Poor spelling, grammar, or organizing written work
 Mathematics (e.g., dyscalculia)
Difficulty with number sense, memorizing math facts, calculation, or
math reasoning (includes dyscalculia)
Causes

Genetic and Hereditary Factors: Learning disorders often run in

families, with higher chances if parents or siblings are affected.

Neurobiological Factors: Brain differences in areas controlling

language, reading, and math can cause problems with memory,
processing speed, or phonological skills.

Prenatal and Perinatal Risks: Premature birth, low birth weight,

oxygen shortage, or maternal issues like substance use and poor nutrition
can increase risk.

Environmental Factors: Poverty, poor diet, and limited learning

opportunities may worsen learning difficulties but are not direct causes.

Cognitive Factors: Weaknesses in phonological awareness (reading),

visual-spatial skills (math), and fine motor coordination (writing)
contribute to specific learning problems.
 Motor Disorders
Motor disorders are conditions that affect a person’s ability to control
body movements.
Developmental Coordination Disorder (DCD)
 Marked impairment in motor coordination (e.g., clumsiness,
dropping things, difficulty with sports, handwriting, or
dressing).
 Interferes with academic achievement, self-care, or play.
Key Features:
 Clumsiness (e.g., dropping or bumping into things).
 Slow, inaccurate, or awkward performance of motor tasks.
 Difficulty in activities like handwriting, using scissors, riding
a bike, tying shoelaces, or participating in sports.
 Motor difficulties interfere with daily living, academic
achievement, or play.

 Stereotypic Movement Disorder (SMD)

 Definition:
Repetitive, seemingly purposeless motor behavior interfering with
functioning and may cause self-injury.
  Examples:
• Hand flapping.
• Rocking body.
• Head banging.

 Tic Disorders
 Definition:
Sudden, rapid, recurrent, non-rhythmic motor movement or
vocalization.
 Onset usually before 18 years.

Types
Provisional Tic Disorder
Motor and/or vocal tics present for less than 1 year
 10-year-old shows repeated shoulder shrugging for less than a
year.

Tourette Disorder
Both multiple motor tics and at least one vocal tics, present for at least 1
year.
 Eye blinking + throat clearing repeatedly for at least a year.
Persistent Motor or Vocal Tic Disorder
Either motor or vocal tics (not both), lasting more than 1 year.
 Child repeatedly sniffs and blinks for more than a years.
Etiology of Motor Disorders

 Genetic Factors: Tic and movement problems can run in families;

some genes are linked to Tourette’s and similar disorders.
 Neurobiological Factors: Differences in brain areas that control
movement and self-control, and imbalances in brain chemicals
(like dopamine and serotonin), can cause symptoms.
 Prenatal and Perinatal Risks: Being born early, with low weight,
or having less oxygen at birth — plus the mother smoking,
drinking, or feeling stress during pregnancy — can increase the
risk.
 Environmental Factors: Stress, sickness, or head injuries can
make tics worse, especially when the person is tired or upset.
 Cognitive/Developmental Factors: People with these disorders
may have trouble with movement coordination, self-control, and
planning or organizing tasks.

ETIOLOGY OF NEURODEVELOPMENTAL DISORDERS

 Genetic factors: Problems in the genes or chromosomes, like in

Down syndrome or Fragile X.
 Prenatal factors: Issues during pregnancy, such as the mother
having an infection or using drugs or alcohol.
 Perinatal factors: Problems that happen around birth, like being
born too early or having birth complications.
 Postnatal factors: Problems after birth, such as brain injury,
exposure to harmful substances, or lack of love and care.
 Multifactorial causes: These conditions usually happen because
of a mix of many different factors, not just one.
 SOMATIC SYMPTOM AND RELATED DISORDERS

Somatic Symptom and Related Disorders are a group of conditions in

which the main focus is on physical symptoms that cause significant
distress and impairment in a person’s daily life. The key issue is not
whether a medical condition is actually present, but rather the person’s
excessive and unhealthy thoughts, feelings, and behaviors related to
those symptoms.

Important: The physical pain and distress are very real to the person.
These disorders are not about faking illness, unlike Factitious
Disorder, where symptoms are intentionally produced for specific
reasons. The real problem lies in the person’s maladaptive response to
their symptoms, not in the symptoms themselves.

Core Features Across Somatic Symptom and Related Disorders

 Prominent Physical Complaints: The person experiences

noticeable physical problems such as pain, fatigue, weakness,
shortness of breath, or even neurological symptoms like paralysis
or seizures.
 Excessive Distress: They feel very anxious and worried about
these symptoms.
 Disproportionate Thoughts: They may think minor symptoms
are signs of a serious illness or keep believing they are sick despite
reassurance from doctors.
 Significant Impairment: Their constant focus on symptoms
affects their work, studies, social activities, and relationships.
 High Use of Healthcare Services: They often visit multiple
doctors, undergo many tests, and frequently seek medical
explanations for their symptoms for instance, Doctor shopping.
Categories of Somatic Symptom and Related Disorders
(Some Intelligent Friends Prefer Fruit Over Unhealthy)
Somatic Symptom Disorder (More than 6 months)
Focus: The Main focus is on one or more chronic physical symptoms
that cause significant distress and impairment in daily life.

Features: The person has excessive and disproportionate thoughts,

feelings, and behaviors related to those symptoms. They spend a great
deal of time and energy thinking about, worrying about, and managing
their symptoms.

Example:

A person with mild arthritis is completely convinced they are becoming

disabled, constantly researches their condition online, and their life
revolves around their pain, despite medical assessments indicating a
good prognosis.
Case Study
Presenting Problem:
Ayesha constantly complains about stomach pain that has lasted for
several months. She visits different doctors and undergoes many
medical tests, but all results come back normal or show only mild
acidity. Despite this, she strongly believes that something is seriously
wrong with her stomach.

Illness Anxiety Disorder (At least 6 months)

Focus: The preoccupation is with the fear of having a serious illness.
The physical symptoms themselves are either absent or very mild.
Key Features: The core problem is health-related anxiety, not the
symptom. Individuals are hyper vigilant about their bodies and
misinterpret normal bodily sensations as signs of a terrible disease.

Example: A person who experiences occasional chest tightness and

becomes convinced they have heart disease, despite multiple normal
cardiac evaluations. They may frequently monitor their pulse, search
online for heart-related symptoms, or avoid physical activity out of fear
of triggering a heart attack

Presenting Problem:
Bilal frequently worries that he might have serious heart disease.
Whenever he feels even a slight chest discomfort or his heart beats
faster (for example, after climbing stairs), he becomes convinced that
he is having a heart attack.
Conversion Disorder/Functional Neurological Symptom Disorder
Focus: The presence of voluntary motor or sensory symptoms that
suggest a neurological condition but cannot be explained by any
known medical condition.
Key Feature: The symptoms are unintentional (the person is not faking)
and are often associated with a preceding psychological conflict.
Common Symptoms: Weakness or paralysis in a limb, tremors,
seizures (non-epileptic), blindness, deafness, or difficulty speaking.
Example: A soldier experiencing extreme conflict about deployment
suddenly develops paralysis in their legs, with no neurological cause
found
Presenting Problem:
Sana suddenly lost her ability to speak (became mute) after a heated
argument with her parents about her choice of career. She could move
her lips, but no sound came out. She appeared frightened and
confused.

Psychological Factors Affecting Other Medical Conditions

Focus: A genuine, diagnosed medical condition is present (e.g., asthma,
diabetes, heart disease).
Key Feature: Psychological factors (like anxiety, denial, stress) are
judged to be adversely influencing the medical condition.
How it Manifests: The psychological factors can worsen the condition,
interfere with treatment, pose additional health risks.
Example: A patient with diabetes who, due to severe depression, stops
checking their blood sugar and taking insulin, leading to dangerous
health risks.
Presenting Problem:
Ahmed has been experiencing frequent asthma attacks during the past
three months, especially before exams. He reports shortness of breath,
tightness in his chest, and wheezing almost every week. His doctor
confirms that his asthma medication is appropriate, but Ahmed often
forgets to use his inhaler regularly.

Factious Disorder
Focus: The conscious falsification of physical or psychological signs of
illness, either in oneself or in someone else (e.g., a child).
Key Feature: The motivation is internal—to play the "sick role" and
receive attention, sympathy, and care. This is different from
malingering, where the motivation is an external reward (e.g., money,
avoiding work).
Example: A person secretly injects themselves with bacteria to induce
an infection and then presents to the hospital as a "mysterious" medical
case.

Presenting Problem:
Ali frequently visits hospitals complaining of high fever and unexplained
infections. Despite several tests, doctors find no clear medical cause for
her symptoms. She often appears very knowledgeable about medical
terms and enjoys talking in detail with doctors and nurses.
Etiology
Biopsychosocial Model
Biological and Genetic factors
Genetic and Emotional Tendency: Some people are born more likely
to feel anxious, worried, or negative — this increases the chance of
developing somatic symptoms.

Brain and Stress System Changes: The brain may sense pain or body
signals more strongly, and the stress system (HPA axis) may be
overactive, making the person more aware of body sensations.

Childhood Illness Experience: Being often sick as a child can make

someone more focused on body symptoms and associate illness with
care and attention.

Psychological factors
Personality Factors: People high in neuroticism and catastrophic
thinking are more likely to worry about minor body sensations and see
them as signs of serious illness.

Attention and Thinking Patterns: They often show hypervigilance

(constantly scanning their body) and misinterpret normal sensations as
dangerous.

Early Life Experiences: Childhood trauma, seeing sick or worried

parents, and difficulty expressing emotions (alexithymia) can lead to
showing emotional pain through physical symptoms.
Social and Environmental factors
Cultural and Social Factors: In some cultures, people express
emotional pain through physical symptoms because talking about
mental health is stigmatized or seen as shameful.

Reinforcement: Symptoms may bring unconscious emotional relief

(primary gain) or attention and care from others (secondary gain),
which can keep the illness behavior going.

Medical and Media Influence: Doctors’ unnecessary tests or media

focus on diseases can increase health anxiety and make people believe
normal sensations mean serious illness.

Treatment
Stresses the importance of a patient-centered, collaborative
care approach.
People with SSRDs often experience real distress and physical
symptoms, but the cause is psychological rather than medical.
If doctors treat them as “faking” or only focus on medical tests, it can
increase anxiety and mistrust.
That’s why collaboration and empathy are key.
 DISSOCIATIVE DISORDERS

Dissociative Disorders involve a disruption in a person’s

consciousness, memory, identity, or perception.

These disruptions cause significant distress and impairment in social,

personal, occupational, or academic or other areas of functioning.

They are often triggered by severe stress or trauma.

Dissociation is a mental process in which a person becomes separated

from their thoughts, feelings, memories, or sense of identity, like when
the mind’s “software” temporarily glitches.

It exists on a Spectrum: almost everyone experiences mild dissociation

at times, such as “highway hypnosis,” when you arrive home but can’t
remember part of the drive because your mind was elsewhere.

It is like a Coping Mechanism: In cases of severe trauma, dissociation

can act as a coping mechanism, allowing the mind to “disconnect” from
an overwhelming experience to help the person survive it.

However, in Dissociative Disorders, this process becomes chronic,

involuntary, and disruptive, which affects a person’s normal
functionality.
Categories of Dissociative Disorders
(Determined Dogs Don’t Offer Umbrellas)

Dissociative Identity Disorder\ Multiple Personality Disorder\ Split

Personality Disorder

Definition:
Dissociative Identity Disorder is characterized by the presence of two or
more distinct personality identities (also called “alters”) within one
person. Each identity has its own pattern of thinking, feeling, and
behaving.

Key Features (DSM-5-TR):

Individuals experience separate selves or identities, which may have

different names, genders, ages, histories, and mannerisms.

There are recurrent episodes of amnesia—an inability to recall everyday

events, important personal information, or traumatic experiences. This
goes beyond ordinary forgetfulness.

The symptoms cause major problems in social, occupational, or other

important areas of functioning.

Key Point:
Switching between identities may occur suddenly and is often triggered
by stress or reminders of past trauma.

Causes:
DID is often linked to severe and repeated childhood trauma,
especially physical, emotional, or sexual abuse, or extreme neglect.
Example:
Sarah discovers clothes in her closet that she doesn’t remember buying.
Her friends sometimes call her “Kate” and mention conversations she
doesn’t recall. She often “comes to” in the middle of activities, feeling
disoriented and confused about how she got there.

Dissociative Amnesia

Definition:
Dissociative Amnesia involves the inability to recall important
personal information, usually after a traumatic or stressful event.
This memory loss goes beyond the normal forgetfulness.

Subtype of Dissociative Amnesia

Dissociative Fugue: In some cases, the person may travel or wander

away from home in a confused state, unable to recall the past, and
sometimes even assumes a new identity.

Key Features (DSM-5-TR):

The person cannot recall important autobiographical information of a

traumatic or stressful nature.

Types of Amnesia:

Localized Amnesia (most common): The person forgets everything

that happened during a specific period of time. For instance, after a car
accident, the person cannot remember anything from that entire day.

Generalized Amnesia (rare): The person forgets their entire life

history and identity, including who they are, where they live, their
family, and other personal details. For instance, a woman is found
wandering and cannot remember her name, job, or past life.
Selective Amnesia: The person remembers some parts of a traumatic
event but not all details. For Instance, a person remembers being in an
accident but cannot recall the moments right before or the sight of an
injured friend.

Key Point:
Reality testing remains intact — the person does not lose touch with
reality or experience delusions or hallucinations.

Causes:

 Severe trauma, stress, or anxiety

 Can be associated with panic disorder or depression

Example:
A soldier returns from combat but cannot remember a particularly
intense firefight that his squad mates describe. He knows he was present,
but the event itself is completely blank in his memory.

Depersonalization\Derealization Disorder

Definition:
This disorder involves persistent or recurrent experiences of:

 Depersonalization: Feeling detached from oneself, as if observing

your thoughts, feelings, or body from outside.
 Derealization: Feeling that the external world is unreal, dreamlike,
foggy, or visually distorted.
Key Features (DSM-5-TR):

 Depersonalization:
o Feeling like an outside observer of your own life.
o Examples: “I feel like I’m watching myself in a movie,” “My
hands don’t feel like they belong to me,” or feeling
emotionally or physically numb.
 Derealization:
o The surroundings seem unreal, artificial, or dreamlike.
o The world may appear foggy, colorless, or distorted.

 The person is aware of reality. He recognizes that these things are

strange and are not truly happening.

Causes:

 Severe stress, trauma, or anxiety

 May occur during panic attacks, fatigue, or substance use

Example:
During a stressful work presentation, Mark suddenly feels as though his
voice is coming from somewhere else. His hands on the podium seem
like they belong to someone else. The room feels unreal, like a movie
set, and the people’s voices sound distant and muffled. Although the
experience feels strange and dreamlike, he knows he is still at work and
that it is not actually happening.
Differential Diagnosis

 Post-Traumatic Stress Disorder (PTSD):

Both disorders involve trauma-related symptoms, but DID
includes identity fragmentation, while PTSD does not.
 Schizophrenia:
In schizophrenia, the person experiences hallucinations,
delusions, and loss of reality testing. In contrast, individuals with
DID maintain reality testing but show separate identities.

Etiology

A. Psychological Factors

 The main cause of dissociative disorders is overwhelming and

chronic trauma, most often beginning in early childhood (before
ages 6–9). When a child experiences repeated abuse, neglect, or
severe stress, the mind uses dissociation as a psychological
escape to survive the pain.

 Lack of a Safe Base: Trauma often occurs within caregiving

relationships, leaving the child without a trusted adult for comfort
or protection.
 Personality Vulnerability: People who are highly imaginative,
emotionally sensitive, or easily influenced are more prone to
develop dissociative symptoms.
 Developmental Disruption: Repeated dissociation during
childhood interferes with the normal development of identity,
memory, and consciousness.
B. Biological Factors

 Changes in brain regions like the hippocampus and amygdala,

which are responsible for memory and emotion.
 Long-term stress affects brain chemistry and how memories are
stored or recalled.

C. Social and Cultural Factors

In some cultures, trance or possession states are considered normal

experiences, which can influence how dissociation is expressed or
understood.

Children or adults without emotional or social support during trauma are

more likely to develop dissociative symptoms.
Treatment
1. Psychotherapy (Main Treatment)

 Trauma-Focused Therapy: Aims to integrate fragmented

identities and traumatic memories into a single, cohesive sense
of self.
 Cognitive Behavioral Therapy (CBT): Helps manage anxiety,
depression, and distorted thoughts related to trauma.
 EMDR (Eye Movement Desensitization and Reprocessing):
Assists in processing traumatic memories in a safe and
controlled way.

2. Medication

 No specific drug treats DID directly, but medications may be

prescribed to reduce associated symptoms such as depression,
anxiety, or PTSD.

3. Grounding Techniques

 Practical exercises that help clients stay connected to the present

moment and reduce dissociation.
o Examples: Focusing on sensory experiences (touch, sound, or
sight), deep breathing, or describing one’s surroundings in
detail.
Other Specified and Unspecified
When Symptoms not neatly fit into the box
Other Specified: Used when symptoms cause distress or impairment in
personal, social, academic, or occupational and other important areas
of functioning but do not meet full criteria for any specific disorder.
Here clinician chooses to specify the reason why the criteria does not
fit.
Unspecified: Used when symptoms cause distress or impairment in
personal, social, academic, or occupational and other important areas
of functioning but insufficient information is available to make a specific
diagnosis. Here clinician chooses not to specify the reason why the
criteria does not fit.