39 Assessment Methods and Techniques: Neurodevelopmental Disorders
Alexandria Lewis
Content Outline, Competency, and KSAs
II. Content Outline: Assessment and Intervention Planning
IIB. Competency: Assessment Methods and Techniques
KSA:
– The use of the Diagnostic and Statistical Manual of the American Psychiatric Association
Overview
Neurodevelopmental disorders are a category of conditions that emerge early in life, typically during the developmental period, and are characterized by deficits or differences in brain functioning. These conditions impact various domains of functioning, including personal, social, academic, and occupational abilities. These diagnoses can include delays in reaching developmental milestones, impairments in cognitive skills, social skills, difficulties with motor coordination, and/or communication.
Neurodevelopmental disorders frequently co-occur, both within the category (e.g., autism spectrum disorder with intellectual developmental disorder) and with other childhood-onset mental health conditions (e.g., ADHD with anxiety or oppositional defiant disorder).
Neurodevelopmental Disorders:
- Intellectual disorders
- Communication disorders
- Autism spectrum disorder
- Attention-Deficit/Hyperactivity disorder
- Special learning disorder
- Motor disorders
- Other developmental disorders
Intellectual Disorders
Intellectual developmental disorder consists of deficits in intellective and adaptive functioning in conceptual, social, and practical domains. The following three criteria are required to diagnosis intellectual developmental disorder.
| Criterion | Description |
| A. | Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. |
| B. | Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community. |
| C. | Onset of intellectual and adaptive deficits during the developmental period. |
Severity examples: mild, moderate, severe, and profound.
| Severity Level | Conceptual Domain | Social Domain | Practical Domain |
| Mild | Difficulties in academic skills (e.g., reading, math, time, money). Abstract thinking and executive function are impaired. | Immature social interactions, difficulty perceiving social cues, and limited understanding of social risks. Gullibility and difficulty regulating behavior. | Age-appropriate personal care with support for complex tasks (e.g., shopping, banking). Competitive employment possible with support. Assistance needed for health and legal decisions. |
| Moderate | Conceptual skills lag significantly. Academic skills remain elementary. Daily conceptual tasks require assistance. | Marked differences in social behavior; communication is less complex. Limited social judgment and decision-making, requiring significant support. | Can care for personal needs with extended teaching. Employment possible in jobs with minimal skills, but ongoing workplace support is needed. Recreational skills require structured opportunities and support. |
| Severe | Little understanding of written language or concepts like time and money. Problem-solving requires extensive caretaker support. | Limited vocabulary; speech focuses on the present. Relationships bring pleasure but are limited to family and familiar individuals. | Fully dependent on support for all daily living activities (e.g., dressing, eating). Requires lifelong supervision and assistance for participation in recreation and home tasks. Maladaptive behaviors (e.g., self-injury) may occur. |
| Profound | Limited to physical world concepts (e.g., sorting objects). Motor and sensory impairments may limit functional skills. | Minimal understanding of speech or gestures. Communication is nonverbal. Social interactions involve emotional and gestural cues. | Fully dependent for physical care and safety. May assist with simple tasks (e.g., carrying objects). Recreational activities (e.g., music, walking) are enjoyed with significant support. Co-occurring physical impairments often limit participation. |
Additional Information:
- Global developmental delay is reserved for situations when someone is under the age of five years old and due to developmental level, they are unable to complete certain assessments of intellectual functioning. This is not a long-term diagnosis and must be reassessed.
Communication Disorders
Communication disorders involve language, speech, and communication deficits:
- Language disorder
- Speech sound disorder
- Childhood-onset fluency disorder (stuttering)
- Social (pragmatic communication disorder
- Unspecified communication disorder
Diagnostic Criteria (click on the dropdown menu):
Autism Spectrum Disorder
The diagnosis of Autism Spectrum Disorder (ASD) requires persistent challenges in social communication and interaction across multiple contexts, alongside restricted, repetitive behaviors or interests. Key criteria include:
- Social communication and interaction deficits.
- Restricted and repetitive behaviors or interests.
- Early onset
- Functional impairment
Highlights
Social Communication and Interaction:
These must be present currently or by history and include:
- Difficulties with social-emotional reciprocity, such as abnormal conversation patterns or reduced sharing of interests and emotions.
- Challenges with nonverbal communication, including poor integration of verbal and nonverbal behaviors, abnormal eye contact, or lack of facial expressions.
- Problems in developing and maintaining relationships, such as difficulty adjusting to social contexts, limited imaginative play, or lack of interest in peers.
Restricted and Repetitive Behaviors or Interests:
At least two of the following must be observed:
- Repetitive motor movements, speech, or use of objects (e.g., echolalia, lining up toys).
- Insistence on sameness or rigid adherence to routines (e.g., distress with changes, strict rituals).
- Intense, fixated interests that are abnormal in focus or intensity.
- Hyper- or hyporeactivity to sensory input or fascination with sensory stimuli (e.g., adverse reactions to sounds or textures).
Severity Level Examples:
- Level 1: Requiring support
- Level 2: Requiring substantial support
- Level 3: Requiring very substantial support
| Severity Level | Social Communication | Restricted, Repetitive Behaviors |
| Level 1
Requiring support |
Noticeable communication deficits without support; difficulty with social interactions and atypical responses. Example: Speaks in full sentences but struggles with back-and-forth conversation or forming friendships. | Inflexibility causes interference in one or more areas; struggles with switching tasks and planning, impacting independence. |
| Level 2
Requiring substantial support |
Marked deficits in communication; limited initiation of interaction; abnormal responses to others’ social overtures. Example: Uses simple sentences, limited to special interests, with odd nonverbal cues. | Frequent inflexibility and difficulty with change; behaviors are obvious to observers and interfere across contexts. Distress when shifting focus. |
| Level 3
Requiring very substantial support |
Severe deficits in verbal and nonverbal communication; minimal social interaction; limited responses to others. Example: Rarely initiates interaction, uses few intelligible words, and responds only to direct approaches. | Inflexibility and extreme difficulty with change severely impair functioning in all areas; great distress when changing focus or actions. |
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Symptoms must be present for at least 6 months, inconsistent with developmental level, and negatively impact daily functioning in settings such as school, work, or home.
- Inattention includes symptoms like difficulty sustaining attention, forgetfulness, disorganization, or losing necessary items. Individuals may seem not to listen, fail to follow through on tasks, or avoid activities requiring sustained focus.
- Hyperactivity-Impulsivity involves excessive movement (e.g., fidgeting, leaving seats), talking excessively, or acting without thinking (e.g., blurting out answers, interrupting others). Individuals may also struggle to wait their turn or feel restless.
Symptoms must:
- Appear in multiple settings (e.g., home, school, work).
- Begin before age 12.
- Cause clear impairment in social, academic, or occupational functioning.
ADHD is not better explained by other mental health or medical conditions and often persists into adulthood, significantly impacting daily life.
Specify
Specific Learning Disorder
Specific Learning Disorder (SLD) involves persistent difficulties in learning and using academic skills despite targeted interventions, lasting for at least six months. These difficulties can occur in the domains of reading, written expression, or mathematics and must significantly interfere with academic, occupational, or daily functioning.
Specify
- Word reading accuracy
- Reading rate or fluency
- Reading comprehension
- Spelling accuracy
- Grammar and punctuation accuracy
- Clarity or organization of written expression
- Number sense
- Memorization of arithmetic facts
- Accurate or fluent calculation
- Accurate math reasoning
Specify if:
- Mild
- Moderate
- Severe
Motor Disorders
Motor Disorders include challenges in the development and execution of motor skills that significantly interfere with daily functioning.
This category includes several diagnoses:
- Developmental coordination disorder
- Stereotypic movement disorder
- Tic disorder
- Tourette’s disorder
- Persistent (chronic) motor or vocal tic disorder
- Provisional tic disorder
- Other specified tic disorder
- Unspecified tic disorder
Other Neurodevelopmental Disorders
This category includes two disorders:
- Other specified neurodevelopmental disorder (F88) is used when symptoms cause significant impairment in functioning but do not fully meet criteria for a specific neurodevelopmental disorder. The clinician specifies the reason, such as “neurodevelopmental disorder associated with prenatal alcohol exposure,” which involves developmental disabilities resulting from in utero alcohol exposure. This category provides flexibility for documenting atypical presentations.
- Unspecified neurodevelopmental disorder (F89) is used when symptoms of a neurodevelopmental disorder significantly impair functioning but do not meet the full criteria for a specific diagnosis, and the clinician opts not to specify why. This category is often applied in situations where there is insufficient information to make a detailed diagnosis, such as in emergency settings.
Self-Check
The following question style is more likely to be on the clinical exam. There are more reasoning questions on the clinical exam for diagnosis than the Masters exam.
