Currently, there is an increase in emotional and behavioral alterations in childhood and adolescence (Instituto Nacional de Salud Mental Honorio Delgado- Hideyo Noguchi [INSM HD-HN], 2012), which can be described and explained depending on their etiology, symptomatology and dysfunctionality in childhood and adolescent disorders, among which are neurodevelopmental disorders.
Childhood and adolescent disorders have different etiologies from a biological, psychological and social perspective. One of these large groups is made up of neurodevelopmental disorders. This group of disorders is characterized by a delay in the growth and maturation of the brain associated with cognitive, emotional and behavioral dysfunction (Artigas-Pallarés, Guitart & Gabau-Vila, 2013). Next, we will describe the neurodevelopmental construct, the classification of neurodevelopmental disorders, their comorbid conditions and their evaluation from a neuropsychological perspective.
Neurodevelopment implies a constant interaction between the organism and the environment, where different capacities, abilities, skills, abilities, attitudes, etc., are progressively formed, in which the nervous system enters a maturation process and together with the social environment allows the development of brain functions, as well as personality (Gutiérrez, Lazarte & Alarcón, 2016).
In addition, it allows the maturation of cognitive, motor and emotional abilities, although part of a similar process, each person has its own rhythm, being a nexus for an adequate interaction of genetics, stimulation and affectivity (Medina-Alva, et al., 2015). Consequently, its delay can originate a lesser connection and development of the brain being described through neurodevelopmental disorders.
What are neurodevelopmental disorders?
Neurodevelopmental disorders are problems associated with a lower functioning and development of the nervous system that begins in early childhood and is usually manifested in motor, behavioral, social interaction, language and learning alterations (Galán-López, Lascarez-Martínez, Gómez-Tello & Galicia-Alvarado, 2017).
Classification of neurodevelopmental disorders.
Montes, Bembibre, Triviño & Arnedo (2015) classify neurodevelopmental disorders into genetic, environmental etiology and those defined by their ultimate impact. In the measure that signals alarm and abnormal risk factors are identified prenatally, perinatally or postnatally, their evolution and/or prognosis can be known (Ponce-Meza, 2017).
The most common genetic disorders are Down syndrome, Edwards syndrome, Klinefelter syndrome, etc; among the disorders of environmental etiology are those derived from drug use, malnutrition, parasitic or bacterial infections; and disorders of functional impact include attention deficit hyperactivity disorder, autism spectrum disorder, language disorder, learning disorders and intellectual disability.
Depending on their diverse etiology, it is advisable to detect them in order to subsequently provide strategies to stimulate their abilities and altered circuits for a greater potential for their development (Artigas-Pallarés, Guitart, Gabau-Villa, 2013). It can be approached from a neurological, psychiatric and psychological point of view. One of the specialties of psychology that deals with the detection, evaluation, diagnosis and intervention of neurodevelopmental delays and/or disorders is child neuropsychology (Arango- Lasprilla, Rivera, & Olabarrieta- Landa, 2017).
Child neuropsychology is a behavioral neuroscience that studies the relationships between behavior and the developing brain (Cuervo & Avila, 2010). This specialty is responsible from a neuropsychological approach to neurodevelopmental disorders such as attention deficit hyperactivity disorder ADHD, autism spectrum disorders ASD, congenital malformations, congenital disorders and learning disabilities (Montes, Bembibre, Triviño & Arnedo, 2015).
The theoretical framework of child neuropsychology consists of the relationship that the child’s brain has with its environment, in which the different brain areas and cognitive functions are constantly maturing, thus allowing greater functionality and adaptation to respond to different situations that the child has to go through. Meanwhile if there were a neurocognitive delay, brain plasticity will allow compensating and restoring these deficiencies (Arango- Lasprilla, Romero, Hewitt- Ramirez, & Rodriguez, 2018).
Role of the child neuropsychologist
One of the functions of the child neuropsychologist is the neuropsychological assessment, i.e., the use of techniques and instruments to evaluate the development of cognitive, emotional and behavioral functions resulting from the functioning of the developing nervous system (Portellano & García, 2014). This allows contributing to the differential diagnosis of different infant and juvenile conditions such as neurodevelopmental disorders, externalizing disorders, internalizing disorders, etc (Arango- Lasprilla, Rivera, & Olabarrieta-Landa, 2017). From a practical description, the parents are interviewed to collect the reason for consultation and the neuropsychological clinical history, the cognitive areas are explored with neuropsychological instruments and it is observed how the child responds to the tasks (stimuli) presented and if they are congruent to their chronological age (Oré, 2019).
Neurodevelopmental disorders and comorbidity
Most neurodevelopmental disorders do not manifest independently with a similar course, main symptoms or with a specific age of onset, so their diagnosis is confusing or incomplete; within a care activity they usually present as comorbid or associated conditions. Comorbidity, therefore, consists of the appearance in the same person of two or more pathologies, where the appearance of one determines its prognosis and intervention process (Montes, Bembibre, Triviño, & Arnedo, 2015).
The disorders with the greatest comorbidity correspond to ADHD and ASD. Although each of these disorders has main symptoms that characterize it from others, it is advisable to explore other pictures that are associated (Arango- Lasprilla, Romero, Hewitt- Ramírez & Rodríguez, 2018).
ADHD is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity and impulsivity (American Psychiatric Association, 2015). Below, we detail its 3 predominances: inattentive, hyperactive and combined (inattention, hyperactivity and impulsivity). In addition, its major comorbidities are Learning Disorders (LD), Conduct Disorders (CD) and Anxiety Disorders (AD).
Subtypes and comorbidities
Inattentive-predominantly ADHD is often associated with Learning Disorders (LD), commonly with literacy problems (Scandar, 2013). It is worth mentioning that both problems are in the category of neurodevelopmental disorders. Therefore, a deficit in attentional functions would generate difficulties in learning areas of reading, writing, spelling. Mostly this is observed in girls compared to boys in a care environment.
ADHD with hyperactive-impulsive and combined predominance, i.e., with greater hyperactivity and impulsivity symptoms, is associated or differentiated with other behavioral disorders or also called externalizing disorders such as Oppositional Defiant Behavior Disorder (ODD) or Dissocial Behavior Disorder (DCD) (Baca, 2012).
Differences with other disorders
One of the main differences stems from the etiology of the problem, mostly ADHD children have problems in their developmental process where they show cognitive and emotional immaturity, while OCD and CDD are usually caused by a harmful and inadequate environment that reinforces their maladaptive behaviors causing children not to respect social norms. Similarly, according to the evolution of the problem, while in children with ADHD symptoms are expected to decrease in adolescence, in OCD the maladaptive problems may increase, leading to the development of CDD. If the symptoms of these disorders start at a younger age the prognosis tends to be unfavorable (Arango- Lasprilla, Romero, Hewitt- Ramirez, & Rodriguez, 2018).
Likewise, it is usually appreciable another relationship with mood disorders, specifically with greater frequency in anxious pictures and to a lesser extent in depressive pictures. This would imply that the child with ADHD feels down, worried, tense, pessimistic and with feelings of guilt because he or she cannot perform in academic or social areas like other children in his or her environment. These symptoms and even more their differences are difficult to determine because their social environment such as family, teachers and peer groups would be more aware of their hyperactivity and attention problems. For this reason, it is recommended to find out if there are family members with a history of emotional problems. It is also important to know if the main symptoms of ADHD have generated depressive and/or anxious symptomatology (López-Villalobos, Serrano & Sánchez-Mateos, 2013).
ASD is a neurodevelopmental disorder whose impairments focus on communication and social interaction such as restrictive and repetitive patterns of behaviors, interests and activities (American Psychiatric Association APA, 2015). Next, we delve into their major comorbidities such as epilepsy, ADHD, intellectual disability (ID), sleep disorders, anxiety disorders, aggression and a deficit in social skills.
Epilepsy has a large neuropsychological component, so it is important to detect early-onset cognitive deficits and differentiate them from other conditions (Arango- Lasprilla, Romero, Hewitt- Ramírez & Rodríguez, 2018). Mostly in ASD and epilepsy, intellectual disability is found, as well as alterations in language, declarative memory and executive functions, which would bring a worse prognosis in the development and functionality of the child (García-Peñas, 2009).
Some 20% to 30% of children with ADHD may present ASD (Rico-Moreno & Tárraga-Mínguez, 2016). The comorbidity of both conditions could be explained by an alteration in the development of executive functions. In fact, in both disorders it is observed that children show a maturational delay in the executive functioning of inhibitory control, cognitive flexibility and planning. A demarcation between executive performance would understand that ASD present greater difficulties in cognitive flexibility and abstraction; however, in ADHD the executive deficit would correspond to inhibitory control and working memory (Portellano and García, 2014).
Regarding ID and ASD we can indicate similarities in the alterations associated with intellectual performance. Mostly in both disorders a below average IQ is observed, as well as difficulties in their social maturity, due to their poor adaptation to change and decreased cognitive flexibility except in the case of high-functioning ASD such as Asperger Syndrome where their intellectual performance stands out compared to other children (Montes, Bembibre, Triviño, & Arnedo, 2015).
Finally, sleep disorders, anxiety disorders and aggressiveness would be secondary alterations within ASD. Moreover, depending on the possible etiology and comorbidity, alterations of insomnia, night terrors, tension, fear, worry and even impulsive reactions that break social norms would be observed (Arango- Lasprilla, Romero, Hewitt- Ramirez, & Rodriguez, 2018).
The importance of neuropsychological assessment
Therefore, it is of great importance to perform a neuropsychological evaluation in the different neurodevelopmental disorders or alterations since it allows detecting the cognitive performance either in strengths, weaknesses or average performances. These results together with the psychopathological exploration generate a better analysis to detect the appearance, evolution and prognosis of the problem that would lead to an adequate diagnosis and therefore to a good start of the neuropsychological, psychological, neurological or psychiatric intervention considering its comorbidity in each case (Pardos, 2019).
The article allows understanding the characteristics of neurodevelopmental disorders, being one of the main manifestations, the delay in growth and / or maturation of the brain, which results in cognitive, emotional, behavioral and social dysfunction in the child and adolescent.
Likewise, its classification was described based on genetic disorders, disorders of environmental etiology and disorders defined by their final repercussions. Specifically in the latter group are attention deficit hyperactivity disorder, autism spectrum disorder, language disorder, learning disorders and intellectual disability.
Meanwhile, one of the disciplines that is responsible for its study from a welfare field is child neuropsychology, either by performing activities of detection, evaluation and intervention of the brain-behavioral relationship in neurodevelopmental disorders.
On the other hand, most of the neurodevelopmental disorders show comorbid conditions, being the most comorbid attention deficit hyperactivity disorder and autism spectrum disorder, however, there are other conditions that also need to be detected, described and differentiated in order to have a better analysis of their prognosis, diagnosis and intervention, being one of the most important procedures the neuropsychological evaluation.
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