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Neurodevelopmental disorders (NDD) are a consequence of underlying dysfunction in neurological development and information processing - or cognitive functioning: they are largely genetic and otherwise biological; they are mediated by psycho-social-emotional processes
They rarely relate neatly to specific areas of dysfunction: it is very common to find disparate areas of functional and neuropsychological impairment
Some exceptions to this are the very specific impairments in phonological processing (corresponding with structural abnormalities in the auditory cortex) that occur in narrow dyslexia
Separation of complex NDD into different services or pathways is highly advised against: ASD and ADHD are so closely related (in terms of comorbidity and underlying information processing) that it makes no sense from any perspective
The first question has to be: Is there, or has there been, evidence of clinically significant (functional) impairment or distress? If yes, it is very likely there is a diagnosable disorder. If no, there can be no diagnosis. It is professionally remiss to identify such impairments and think that there might not be a diagnosis.
The second question has to be: Are the identified problems a reflection of neurodevelopment? If yes, then an NDD diagnosis or diagnoses must be given, even if it is an Other Specified Neurodevelopmental Disorder (OSND) - which is given when the specific criteria for a single diagnosis are not met (e.g. when problems are spread across multiple areas, which is very common)
Where there are no grounds for thinking that other factors have impinged on the child, it is usually possible to determine from a proper developmental history whether the issues are neurodevelopmental
Where a child has experienced some sort of psycho-social adversity, it can be more difficult to tease apart the respective roles of neurodevelopment and general psychological development - but there is considerable ingrained confusion about this, see Autism and Attachment - Part 1
In either case, a proper cognitive or educational neuropsychological assessment will show if there are underlying neurodevelopmental abnormalities: these are most often seen in executive functioning (EF), motor control (MC) and processing speed (but can be found in very large general discrepancies or any evidently unusual aspect of cognitive development)
The presence of neuropsychological issues is not in itself diagnostic: that depends on the identified functional impairments and whether they meet clinical significance
It is very common for people with clinically significant neurodevelopmental problems to meet criteria for more than one NDD diagnosis: "Specific learning disorder commonly co-occurs with neurodevelopmental (e.g., ADHD, communication disorders, developmental coordination disorder, autistic spectrum disorder) or other mental disorders (e.g., anxiety disorders, depressive and bipolar disorders). These comorbidities do not necessarily exclude the diagnosis specific learning disorder but may make testing and differential diagnosis more difficult, because each of the cooccurring disorders independently interferes with the execution of activities of daily living, including learning" (DSM-5)
NDD are also highly comorbid with other diagnoses: "About 70% of individuals with autism spectrum disorder may have one comorbid mental disorder, and 40% may have two or more comorbid mental disorders…In clinical settings, comorbid disorders are frequent in individuals whose symptoms meet criteria for ADHD. In the general population, oppositional defiant disorder co-occurs with ADHD in approximately half of children with the combined presentation and about a quarter with the predominantly inattentive presentation" (DSM-5)
There is increasing evidence that girls in particular are under-diagnosed with ASD-type NDD: this is, in part, because the criteria themselves have been devised in relation to the presentation in boys
There is increasing evidence that being the parent of a child with an ASD-type NDD makes it significantly more likely that you will be subject to child protection concerns: it seems that one in 30 children with autism are adopted following child protection proceedings; this is likely to be for a mixture of valid and erroneous reasons (such as mistaking social developmental problems for attachment disorders or neglect) - see Autism and Motherhood
Basic tests of cognitive ability (e.g. WISC) and attainment (e.g. WIAT) are generally insufficient to provide a profile of neuropsychological functioning: tests of EF, MC and attention in particular are usually needed
The interpretation of neuropsychological tests is the critical factor: in all but the most simple case, this might require the input of a professional (e.g. a Clinical or Educational Psychologist) with specific training and experience in developmental cognitive neuropsychology or educational neuropsychology
It is generally not appropriate to give tests or make assessments on the basis that 'condition X' is being assessed for: the assessment must start with the functional impairment question and any diagnoses should flow from a properly-structured overall assessment - to do otherwise would be akin to assessing for schizophrenia and then deciding there is no evidence of a disorder when those specific criteria are not met
More complex NDD are often correctly diagnosed as OSND as, whilst there is clear evidence of functional impairment and/or distress, the symptoms may not fully meet a standard set of criteria - or the standard diagnoses do not adequately characterise the range of impairments
New Section
Considerations when Configuring Neurodevelopmental Services and Undertaking Related Assessments
