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Moreover, it's noteworthy that the occurrence of ASD in one child can substantially elevate the risk of the next child being diagnosed with ASD. Research suggests that the risk for a subsequent child developing ASD can be increased by 50 to 100 times when compared to families without a history of the disorder. This highlights the importance of both early intervention and ongoing research efforts to better understand the factors contributing to ASD, thereby improving diagnostic accuracy and developing effective interventions.<ref>Alpert JS. Autism: A Spectrum Disorder. Am J Med. 2021 Jun;134(6):701-702. doi: 10.1016/j.amjmed.2020.10.022. Epub 2020 Nov 9. PMID: 33181106.</ref>
Moreover, it's noteworthy that the occurrence of ASD in one child can substantially elevate the risk of the next child being diagnosed with ASD. Research suggests that the risk for a subsequent child developing ASD can be increased by 50 to 100 times when compared to families without a history of the disorder. This highlights the importance of both early intervention and ongoing research efforts to better understand the factors contributing to ASD, thereby improving diagnostic accuracy and developing effective interventions.<ref>Alpert JS. Autism: A Spectrum Disorder. Am J Med. 2021 Jun;134(6):701-702. doi: 10.1016/j.amjmed.2020.10.022. Epub 2020 Nov 9. PMID: 33181106.</ref>


====Abnormalities in the brain====
The precise cause of Autism Spectrum Disorder (ASD) remains uncertain, but it is established that individuals with ASD experience pervasive challenges in how their brains are wired. Several genes associated with neurotransmitter receptors, specifically serotonin and gamma-aminobutyric acid (GABA), as well as genes involved in central nervous system (CNS) structural control, such as HOX genes, are identified as potential targets affected in ASD. This complex interplay of genetic factors contributes to the multifaceted nature of ASD.
The cause of ASD is still uncertain. What is known is that a child with ASD has a pervasive problem with how the brain is wired. Genes related to neurotransmitter receptors (serotonin and gamma-aminobutyric acid [GABA]) and CNS structural control (''HOX'' genes) are found to be potential target genes that get affected in ASD.<ref name="msdmanuals.com">{{Cite web|url=https://www.msdmanuals.com/en-in/professional/pediatrics/learning-and-developmental-disorders/autism-spectrum-disorders|title=Autism Spectrum Disorders - Pediatrics|website=MSD Manual Professional Edition|access-date=2019-10-30}}</ref> Autism spectrum disorder is a disorder of the many parts of the brain. Structural changes are observed in the cortex, which controls higher functions, sensation, muscle movements, and memory. Structural defects are seen in the cerebellum too, which affect the motor and communication skills.<ref>{{Cite web|url=https://factdr.com/health-conditions/autism/|title=Autism: Facts, causes, risk-factors, symptoms, & management|date=2018-06-25|website=FactDr|access-date=2019-10-30}}</ref> Sometimes the left lobe of the brain is affected and this causes neuropsychological symptoms. The distribution of white matter, the nerve fibers that link diverse parts of the brain, is abnormal. The corpus callosum, the band of nerve fibers, that connects the left and right hemispheres of the brain also gets affected in ASD. A study also found that 33% of people who have AgCC (agenesis of the corpus callosum), a condition in which the corpus callosum is partially or completely absent, had scores higher than the autism screening cut-off.<ref>{{Cite journal|last1=Lau|first1=Yolanda C.|last2=Hinkley|first2=Leighton B. N.|last3=Bukshpun|first3=Polina|last4=Strominger|first4=Zoe A.|last5=Wakahiro|first5=Mari L. J.|last6=Baron-Cohen|first6=Simon|last7=Allison|first7=Carrie|last8=Auyeung|first8=Bonnie|last9=Jeremy|first9=Rita J.|last10=Nagarajan|first10=Srikantan S.|last11=Sherr|first11=Elliott H.|date=May 2013|title=Autism traits in individuals with agenesis of the corpus callosum|journal=Journal of Autism and Developmental Disorders|volume=43|issue=5|pages=1106–1118|doi=10.1007/s10803-012-1653-2|issn=0162-3257|pmc=3625480|pmid=23054201}}</ref>


An ASD child's brain grows at a very rapid rate and is almost fully grown by the age of 10.<ref name="Dereu, Mieke 2010" /> Recent fMRI studies have also found altered connectivity within the social brain areas due to ASD and may be related to the social impairments encountered in ASD.<ref name="Gotts et al">{{cite journal |journal=Brain |year=2012 |volume=135 |issue=9 |pages=2711–2725 |title= Fractionation of social brain circuits in autism spectrum disorders |author= Gotts S. J. |author2=Simmons W. K. |author3=Milbury L. A. |author4=Wallace G. L. |author5=Cox R. W. |author6=Martin A. |pmid= 22791801|doi=10.1093/brain/aws160 |pmc=3437021}}</ref><ref name="Subbaraju et al">{{cite journal |journal=European Journal of Neuroscience|year=2017 |title= Identification of lateralized compensatory neural activities within the social brain due to autism spectrum disorder in adolescent males |vauthors= Subbaraju V, Sundaram S, Narasimhan S |volume=47 |issue=6 |pages=631–642 |doi=10.1111/ejn.13634 |pmid=28661076 |s2cid=4306986 }}</ref>
ASD is characterized by abnormalities in various parts of the brain, reflecting its wide-ranging impact. Structural changes are evident in the cortex, a region responsible for higher cognitive functions, sensation, muscle movements, and memory. Concurrently, observable defects in the cerebellum, a brain region crucial for motor skills and communication, further underscore the diverse neurological manifestations of ASD. Neuropsychological symptoms may arise when the left lobe of the brain is affected.
 
Notably, abnormalities extend to the distribution of white matter, the nerve fibers linking different brain regions, contributing to the atypical connectivity observed in individuals with ASD. The corpus callosum, a band of nerve fibers connecting the left and right hemispheres of the brain, is also affected in ASD. Intriguingly, a study has revealed a correlation between ASD and agenesis of the corpus callosum (AgCC), a condition where the corpus callosum is partially or completely absent. Approximately 33% of individuals with AgCC scored higher than the autism screening cut-off, emphasizing the involvement of this critical neural structure in ASD.
 
The developmental trajectory of an ASD child's brain is characterized by rapid growth, with the brain nearly reaching full maturity by the age of 10. Recent functional magnetic resonance imaging (fMRI) studies have illuminated altered connectivity within the social brain areas in individuals with ASD. This altered connectivity is thought to be linked to the social impairments commonly observed in individuals with ASD. As research progresses, these insights into the structural and functional aspects of the brain in ASD contribute to a deeper understanding of the neural underpinnings of the disorder.<ref>Khalil A, Bennet S, Thilaganathan B, Paladini D, Griffiths P, Carvalho JS. Prevalence of prenatal brain abnormalities in fetuses with congenital heart disease: a systematic review. Ultrasound Obstet Gynecol. 2016 Sep;48(3):296-307. doi: 10.1002/uog.15932. PMID: 27062519.</ref>


====Symptoms====
====Symptoms====

Revision as of 21:15, 25 January 2024

Template:Distinguish Template:Infobox medical condition (new) Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term.[1] The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10.[1] These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders.[2] In broader definitions ADHD is included, and the term used is neurodevelopmental disorders.[1] Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life.[1] However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.[1]

Developmental disorders are present from early life onward. Most improve as the child grows older, but some entail impairments that continue throughout life.

Developmental disorders are different from Pervasive development disorders (PDD), which uniquely describe a group of five developmental diagnoses, one of which is autism spectrum disorders (ASD). Developmental disorders, which similarly to PDD contain autism spectrum disorders, broadly encompass learning disabilities, attention-deficit hyperactivity disorder (ADHD), communication disorders, tic disorders (Tourette syndrome), genetic disorders, and intellectual disabilities. Pervasive developmental disorders reference a limited number of conditions whereas development disorders are a broad network of social, communicative, physical, genetic, intellectual, behavioral, and language concerns and diagnoses.

Emergence

Learning disabilities are diagnosed when the children are young and just beginning school. Most learning disabilities are found under the age of 9.[3]

Young children with communication disorders may not speak at all, or may have a limited vocabulary for their age.[4] Some children with communication disorders have difficulty understanding simple directions or are unable to name objects.[4] Most children with communication disorders are able to speak by the time they enter school, however, they continue to have problems with communication.[4] School-aged children often have problems understanding and formulating words.[4] Teens may have more difficulty with understanding or expressing abstract ideas.[4]

Causes

The scientific study of the causes of developmental disorders involves many different theories. Some of the major differences between these theories involves whether or not environment disrupts normal development, if abnormalities are pre-determined, or if they are products of human evolutionary history which become disorders in modern environments (see evolutionary psychiatry).[5] Normal development occurs with a combination of contributions from both the environment and genetics. The theories vary in the part each factor has to play in normal development, thus affecting how the abnormalities are caused.[5]

One theory that supports environmental causes of developmental disorders involves stress in early childhood. Researcher and child psychiatrist Bruce D. Perry, M.D., Ph.D, theorizes that developmental disorders can be caused by early childhood traumatization.[6] In his works he compares developmental disorders in traumatized children to adults with post-traumatic stress disorder, linking extreme environmental stress to the cause of developmental difficulties.[6] Other stress theories suggest that even small stresses can accumulate to result in emotional, behavioral, or social disorders in children.[7]

A 2017 study[8][9] tested all 20,000 genes in about 4,300 families with children with rare developmental difficulties in the UK and Ireland in order to identify if these difficulties had a genetic cause. They found 14 new developmental disorders caused by spontaneous genetic mutations not found in either parent (such as a fault in the CDK13 gene). They estimated that about one in 300 children are born with spontaneous genetic mutations associated with rare developmental disorders.[10]

Types

Autism spectrum disorder (ASD)

The first documented case of Autism Spectrum Disorder (ASD) dates back to 1943 when American psychiatrist Leo Kanner published his observations. Given the broad spectrum of cases and varying severity levels within ASD, detecting the initial signs of the disorder can be challenging. While a precise diagnosis of ASD can be made before a child turns 3 years old, it is more commonly confirmed when the child is somewhat older. In the United States, the age of diagnosis spans from as early as 9 months to as late as 14 years, with a mean age of 4 years.

Typically, each case of ASD undergoes evaluation at three different diagnostic centers before a confirmation is made. Early diagnosis plays a pivotal role in alleviating familial stress, expediting referrals to specialized educational programs, and influencing family planning decisions. Recognizing and addressing ASD at an early age can significantly improve outcomes for the affected child and their family.

Moreover, it's noteworthy that the occurrence of ASD in one child can substantially elevate the risk of the next child being diagnosed with ASD. Research suggests that the risk for a subsequent child developing ASD can be increased by 50 to 100 times when compared to families without a history of the disorder. This highlights the importance of both early intervention and ongoing research efforts to better understand the factors contributing to ASD, thereby improving diagnostic accuracy and developing effective interventions.[11]

The precise cause of Autism Spectrum Disorder (ASD) remains uncertain, but it is established that individuals with ASD experience pervasive challenges in how their brains are wired. Several genes associated with neurotransmitter receptors, specifically serotonin and gamma-aminobutyric acid (GABA), as well as genes involved in central nervous system (CNS) structural control, such as HOX genes, are identified as potential targets affected in ASD. This complex interplay of genetic factors contributes to the multifaceted nature of ASD.

ASD is characterized by abnormalities in various parts of the brain, reflecting its wide-ranging impact. Structural changes are evident in the cortex, a region responsible for higher cognitive functions, sensation, muscle movements, and memory. Concurrently, observable defects in the cerebellum, a brain region crucial for motor skills and communication, further underscore the diverse neurological manifestations of ASD. Neuropsychological symptoms may arise when the left lobe of the brain is affected.

Notably, abnormalities extend to the distribution of white matter, the nerve fibers linking different brain regions, contributing to the atypical connectivity observed in individuals with ASD. The corpus callosum, a band of nerve fibers connecting the left and right hemispheres of the brain, is also affected in ASD. Intriguingly, a study has revealed a correlation between ASD and agenesis of the corpus callosum (AgCC), a condition where the corpus callosum is partially or completely absent. Approximately 33% of individuals with AgCC scored higher than the autism screening cut-off, emphasizing the involvement of this critical neural structure in ASD.

The developmental trajectory of an ASD child's brain is characterized by rapid growth, with the brain nearly reaching full maturity by the age of 10. Recent functional magnetic resonance imaging (fMRI) studies have illuminated altered connectivity within the social brain areas in individuals with ASD. This altered connectivity is thought to be linked to the social impairments commonly observed in individuals with ASD. As research progresses, these insights into the structural and functional aspects of the brain in ASD contribute to a deeper understanding of the neural underpinnings of the disorder.[12]

Symptoms

The symptoms have a wide range of severity. The symptoms of ASD can be broadly categorised[13] as the following:

Persistent issues in social interactions and communications

These are predominantly seen by unresponsiveness in conversations, lesser emotional sharing, inability to initiate conversations, inability to interpret body language, avoidance of eye-contact and difficulty maintaining relationships.Template:Cn

Repetitive behavioral patterns

These patterns can be seen in the form of repeated movements of the hand or the phrases used while talking. A rigid adherence to schedules and inflexibility to adapt even if a minor change is made to their routine is also one of the behavioral symptoms of ASD. They could also display sensory patterns such as extreme aversion to certain odors or indifference to pain or temperature.Template:Cn

There are also different symptoms at different ages based on developmental milestones. Children between 0 and 36 months with ASD show a lack of eye contact, seem to be deaf, lack a social smile, do not like being touched or held, have unusual sensory behavior and show a lack of imitation. Children between 12 and 24 months with ASD show a lack of gestures, prefer to be alone, do not point to objects to indicate interest, are easily frustrated with challenges, and lack of functional play. And finally children between the ages 24 to 36 months with ASD show a lack of symbolic play and an unusual interest in certain objects, or moving objects.[14]

Treatment

There is no specific treatment for autism spectrum disorders, but there are several types of therapy effective in easing the symptoms of autism, such as Applied Behavior Analysis (ABA), Speech-language therapy, Occupational therapy or Sensory integration therapy.Template:Cn

Applied behavioral analysis (ABA) is considered the most effective therapy for Autism spectrum disorders by the American Academy of Pediatrics.[15] ABA focuses on teaching adaptive behaviors like social skills, play skills, or communication skills[16][17] and diminishing problematic behaviors like self-injury.[18] This is done by creating a specialized plan that uses behavioral therapy techniques, such as positive or negative reinforcement, to encourage or discourage certain behaviors over-time.[19]

Occupational therapy helps autistic children and adults learn everyday skills that help them with daily tasks, such as personal hygiene and movement. These skills are then integrated into their home, school, and work environments. Therapists will oftentimes help patients learn to adapt their environment to their skill level.[20] This type of therapy could help autistic people become more engaged in their environment.[21] An occupational therapist will create a plan based on the patient's needs and desires and work with them to achieve their set goals.Template:Cn

Speech-language therapy can help those with autism who need to develop or improve communication skills. According to the organization Autism Speaks, “speech-language therapy is designed to coordinate the mechanics of speech with the meaning and social use of speech”.[21] People with low-functioning autism may not be able to communicate with spoken words. Speech-language Pathologists (SLP) may teach someone how to communicate more effectively with others or work on starting to develop speech patterns.[22] The SLP will create a plan that focuses on what the child needs.

Sensory integration therapy helps people with autism adapt to different kinds of sensory stimuli. Many children with autism can be oversensitive to certain stimuli, such as lights or sounds, causing them to overreact. Others may not react to certain stimuli, such as someone speaking to them.[23] Many types of therapy activities involve a form of play, such as using swings, toys and trampolines to help engage the patients with sensory stimuli.[21] Therapists will create a plan that focuses on the type of stimulation the person needs integration with.Template:Cn

Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder is a neurodevelopmental disorder that occurs in early childhood. ADHD affects 8 to 11% of children in the school going age. ADHD is characterised by significant levels of hyperactivity, inattentiveness, and impulsiveness. There are three subtypes of ADHD: predominantly inattentive, predominantly hyperactive, and combined (which presents as both hyperactive and inattentive subtypes).[24] ADHD is twice as common in boys than girls but it is seen that the hyperactive/impulsive type is more common in boys while the inattentive type affects both sexes equally.[25]

Symptoms

Symptoms of ADHD include inattentiveness, impulsiveness, and hyperactivity. Many of the behaviors that are associated with ADHD include poor control over actions resulting in disruptive behavior and academic problems. Another area that is affected by these disorders is the social arena for the person with the disorder. Many children that have this disorder exhibit poor interpersonal relationships and struggle to fit in socially with their peers.[24] Behavioral study of these children can show a history of other symptoms such as temper tantrums, mood swings, sleep disturbances and aggressiveness.[25]

Treatment options

Treatment of ADHD often includes a combination of psychological, behavioural, pharmaceutical and educational advice and interventions.Template:Cn

Behavioral therapy

Sessions of counselling, cognitive behavioral therapy (CBT), making environmental changes in noise and visual stimulation are some behavioral management techniques followed. But it has been observed that behavioral therapy alone is less effective than therapy with stimulant drugs alone.

Drug therapy

Medications commonly used in the treatment of ADHD are primarily stimulants such as methylphenidate and lisdexamphetamine and non-stimulants such as atomoxetine. They could cause side effects such as headache, stomach pain, depression and sleep disturbances.Template:Cn

SSRI antidepressants may be unhelpful, and could worsen symptoms of ADHD.[26] However ADHD is often misdiagnosed as depression, particularly when no hyperactivity is present.

Other disorders

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Michael Rutter, ed (2008). Rutter's Child and Adolescent Psychiatry. Dorothy Bishop and Michael Rutter (5th ed.). Blackwell Publishing. pp. 32–33. ISBN 978-1-4051-4549-7. http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1405145498.html. 
  2. ↑ "ICD 10". http://priory.com/psych/ICD.htm. 
  3. ↑ National, Disabilities Learning (1982). "Learning disabilities: Issues on definition". Asha 24 (11): 945–947. 
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Communication Disorders. (n.d.). Children's Hospital of Wisconsin in Milwaukee, WI, Retrieved December 6, 2011, from http://www.chw.org/display/PPF/DocID/
  5. ↑ 5.0 5.1 Karmiloff Annette (October 1998). "Development itself is key to understanding developmental disorders". Trends in Cognitive Sciences 2 (10): 389–398. doi:10.1016/S1364-6613(98)01230-3. PMID 21227254. 
  6. ↑ 6.0 6.1 Perry, Bruce D. and Szalavitz, Maia. "The Boy Who Was Raised As A Dog", Basic Books, 2006, p.2. Template:ISBN
  7. ↑ Payne, Kim John. “Simplicity Parenting: Using the Extraordinary Power of Less to Raise Calmer, Happier, and More Secure Kids”, Ballantine Books, 2010, p. 9. Template:ISBN
  8. ↑ "Deciphering Developmental Disorders (DDD) project". Wellcome Trust Sanger Institute. https://www.ddduk.org/. 
  9. ↑ McRae, Jeremy F.; Clayton, Stephen; Fitzgerald, Tomas W.; Kaplanis, Joanna; Prigmore, Elena; Rajan, Diana; Sifrim, Alejandro; Aitken, Stuart; et al. (2017). "Prevalence and architecture of de novo mutations in developmental disorders". Nature 542 (7642): 433–438. doi:10.1038/nature21062. PMID 28135719. PMC: 6016744. Bibcode: 2017Natur.542..433M. http://eprints.whiterose.ac.uk/114459/3/emss-78087.pdf. 
  10. ↑ Walsh, Fergus (2017-01-25). "Child gene study identifies new developmental disorders". BBC News. https://www.bbc.co.uk/news/health-38691622. 
  11. ↑ Alpert JS. Autism: A Spectrum Disorder. Am J Med. 2021 Jun;134(6):701-702. doi: 10.1016/j.amjmed.2020.10.022. Epub 2020 Nov 9. PMID: 33181106.
  12. ↑ Khalil A, Bennet S, Thilaganathan B, Paladini D, Griffiths P, Carvalho JS. Prevalence of prenatal brain abnormalities in fetuses with congenital heart disease: a systematic review. Ultrasound Obstet Gynecol. 2016 Sep;48(3):296-307. doi: 10.1002/uog.15932. PMID: 27062519.
  13. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named msdmanuals.com
  14. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Dereu, Mieke 2010
  15. ↑ Myers, Scott M.; Johnson, Chris Plauché (1 November 2007). "Management of Children With Autism Spectrum Disorders". Pediatrics 120 (5): 1162–1182. doi:10.1542/peds.2007-2362. ISSN 0031-4005. PMID 17967921. http://pediatrics.aappublications.org/content/120/5/1162. 
  16. ↑ "Applied Behavioral Analysis (ABA): What is ABA?". 16 June 2011. http://www.autismpartnership.com/applied-behavior-analysis. 
  17. ↑ Matson, Johnny; Hattier, Megan; Belva, Brian (January–March 2012). "Treating adaptive living skills of persons with autism using applied behavior analysis: A review". Research in Autism Spectrum Disorders 6 (1): 271–276. doi:10.1016/j.rasd.2011.05.008. 
  18. ↑ Summers, Jane; Sharami, Ali; Cali, Stefanie; D'Mello, Chantelle; Kako, Milena; Palikucin-Reljin, Andjelka; Savage, Melissa; Shaw, Olivia; et al. (November 2017). "Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input". Brain Sci 7 (11): 140. doi:10.3390/brainsci7110140. PMID 29072583. 
  19. ↑ "Applied Behavioral Strategies - Getting to Know ABA". http://www.appliedbehavioralstrategies.com/what-is-aba.html. 
  20. ↑ Crabtree, Lisa (2018). "Occupational Therapy's Role with Autism". https://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/CY/Fact-Sheets/Autism%20fact%20sheet.ashx. 
  21. ↑ 21.0 21.1 21.2 "What Treatments are Available for Speech, Language and Motor Issues?". https://www.autismspeaks.org/what-autism/treatment/what-treatments-are-available-speech-language-and-motor-impairments. 
  22. ↑ "Speech and Language Therapy". http://www.autismeducationtrust.org.uk/good-practice/written%20for%20you/parents-and-cares/pc%20speech%20and%20language%20therapy.aspx. 
  23. ↑ Smith, M; Segal, J; Hutman, T. "Autism Spectrum Disorders". https://www.helpguide.org/articles/autism-learning-disabilities/autism-spectrum-disorders.htm. 
  24. ↑ 24.0 24.1 Tresco, Katy E. (2004). Attention Deficit Disorders: School-Based Interventions. Pennsylvania: Bethlehem.
  25. ↑ 25.0 25.1 "Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) - Pediatrics". https://www.msdmanuals.com/en-in/professional/pediatrics/learning-and-developmental-disorders/attention-deficit-hyperactivity-disorder-add,-adhd?query=Definition%20of%20Developmental%20Disorders. 
  26. ↑ C. W. Popper (1997). "Antidepressants in the treatment of attention-deficit/hyperactivity disorder". The Journal of Clinical Psychiatry 58 (Suppl 14): 14–29. PMID 9418743. 

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