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Neurodevelopmental Disorders

Attention Deficit/Hyperactivity Disorder | Dyscalculia | Dyslexia | Learning Disorder | Disorder of Written Expression

Neurodevelopmental disorders are diagnostic labels used to describe neurological processing difficulties in understanding and/or using spoken or written language or mathematical calculations or concepts and/or in attending to and focusing on academic tasks. Neurodevelopmental disorders often limit academic fluency such as the speed with which students are able to process and express concepts.

Students enrolled in the Learning Differences Program and the College Transition Program are diagnosed with different combinations of neurodevelopmental disorders and demonstrate different degrees of difficulty and strength in the academic and social environment of Westminster College. A student diagnosed with Dyslexia and Disorder of Written Expression, for example, may be verbally articulate and demonstrate superior mathematical and scientific ability. About 75% of students enrolled in the College Transition Program are diagnosed with both Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder. Sometimes, students enrolled in the Learning Differences Program and the College Transition Program are diagnosed with other disorders such as Anxiety Disorders, like Obsessive-Compulsive Disorder, and Mood Disorders, like BiPolar Disorders or Depressive Disorders.

Proposed revisions for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to be released by the American Psychological Association (APA) in May 2013 currently include the following diagnostic categories and criteria for patterns of behavior and cognitive functioning that substantially interfere with the academic achievement and/or other major life activities of an individual without accommodations. Other diagnostic categories and criteria are located at: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=429 .

Attention Deficit/Hyperactivity Disorder

The disorder consists of a characteristic pattern of behavior and cognitive functioning that is present in different settings where it gives rise to social and educational or work performance difficulties. The manifestations of the disorder and the difficulties that they cause are subject to gradual change being typically more marked during times when the person is studying or working and lessening during vacation.

Superimposed on these short-term changes are trends that may signal some deterioration or improvement with many symptoms becoming less common in adolescence. Although irritable outbursts are common, abrupt changes in mood lasting for days or longer are not characteristic of ADHD and will usually be a manifestation of some other distinct disorder.

In children and young adolescents, the diagnosis should be based on information obtained from parents and teachers. When direct teacher reports cannot be obtained, weight should be given to information provided to parents by teachers that describe the child's behavior and performance at school. Examination of the patient in the clinician's office may or may not be informative. For older adolescents and adults, confirmatory observations by third parties should be obtained whenever possible.

A. Either (1) and/or (2).

  1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. Note: for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.

    (a) Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (for example, overlooks or misses details, work is inaccurate).
    (b) Often has difficulty sustaining attention in tasks or play activities (for example, has difficulty remaining focused during lectures, conversations, or reading lengthy writings).
    (c) Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distraction).
    (d) Frequently does not follow through on instructions (starts tasks but quickly loses focus and is easily sidetracked, fails to finish schoolwork, household chores, or tasks in the workplace).
    (e) Often has difficulty organizing tasks and activities. (Has difficulty managing sequential tasks and keeping materials and belongings in order. Work is messy and disorganized. Has poor time management and tends to fail to meet deadlines.)
    (f) Characteristically avoids, seems to dislike, and is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework or, for older adolescents and adults, preparing reports, completing forms, or reviewing lengthy papers).
    (g) Frequently loses objects necessary for tasks or activities (e.g., school assignments, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile telephones).
    (h) Is often easily distracted by extraneous stimuli. (for older adolescents and adults may include unrelated thoughts.).
    (i) Is often forgetful in daily activities, chores, and running errands (for older adolescents and adults, returning calls, paying bills, and keeping appointments).
  2. Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. Note: for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.
    (a) Often fidgets or taps hands or feet or squirms in seat.
    (b) Is often restless during activities when others are seated (may leave his or her place in the classroom, office or other workplace, or in other situations that require remaining seated).
    (c) Often runs about or climbs on furniture and moves excessively in inappropriate situations. In adolescents or adults, may be limited to feeling restless or confined.
    (d) Is often excessively loud or noisy during play, leisure, or social activities.
    (e) Is often "on the go," acting as if "driven by a motor." Is uncomfortable being still for an extended time, as in restaurants, meetings, etc. Seen by others as being restless and difficult to keep up with.
    (f) Often talks excessively.
    (g) Often blurts out an answer before a question has been completed. Older adolescents or adults may complete people's sentences and "jump the gun" in conversations.
    (h) Has difficulty waiting his or her turn or waiting in line.
    (i) Often interrupts or intrudes on others (frequently butts into conversations, games, or activities; may start using other people's things without asking or receiving permission, adolescents or adults may intrude into or take over what others are doing).
    (j) Tends to act without thinking, such as starting tasks without adequate preparation or avoiding reading or listening to instructions. May speak out without considering consequences or make important decisions on the spur of the moment, such as impulsively buying items, suddenly quitting a job, or breaking up with a friend.
    (k) Is often impatient , as shown by feeling restless when waiting for others and wanting to move faster than others, wanting people to get to the point, speeding while driving, and cutting into traffic to go faster than others.
    (l) Is uncomfortable doing things slowly and systematically and often rushes through activities or tasks.
    (m) Finds it difficult to resist temptations or opportunities , even if it means taking risks (A child may grab toys off a store shelf or play with dangerous objects; adults may commit to a relationship after only a brief acquaintance or take a job or enter into a business arrangement without doing due diligence).

B. Several noticeable inattentive or hyperactive-impulsive symptoms were present by age 12.

C. The symptoms are apparent in two or more settings (e.g., at home, school or work, with friends or relatives, or in other activities).

D. There must be clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Specify Based on Current Presentation

Dyscalculia

A. Difficulties in production or comprehension of quantities, numerical symbols, or basic arithmetic operations that are not consistent with the person's chronological age, educational opportunities, or intellectual abilities. Multiple sources of information are to be used to assess numerical, arithmetic, and arithmetic-related abilities, one of which must be an individually administered, culturally appropriate, and psychometrically sound standardized measure of these skills.

B. The disturbance in criterion A, without accommodations, significantly interferes with academic achievement or activities of daily living that require these numerical skills.

Dyslexia

A. Difficulties in accuracy or fluency of reading that are not consistent with the person's chronological age, educational opportunities, or intellectual abilities. Multiple sources of information are to be used to assess reading, one of which must be an individually administered, culturally appropriate, and psychometrically sound standardized measure of reading and reading-related abilities.

B. The disturbance in criterion A, without accommodations, significantly interferes with academic achievement or activities of daily living that require these reading skills.

Learning Disorder

A. A group of disorders characterized by difficulties in learning basic academic skills (currently or by history), that are not consistent with the person's chronological age, educational opportunities, or intellectual abilities. Basic academic skills refer to accurate and fluent reading, writing, and arithmetic. Multiple sources of information are to be used to assess learning, one of which must be an individually administered, culturally appropriate, and psychometrically sound standardized measure of academic achievement.

B. The disturbance in criterion A, without accommodations, significantly interferes with academic achievement or activities of daily living that require these academic skills.

The following neurodevelopmental disorder was not updated for the DSMV as of March 1, 2012; therefore, was taken from the DSMIV.

Disorder of Written Expression

A. Writing skills, as measured by individually administered standardized tests (or functional assessments of writing skills), are substantially below those expected given the person's chronological age, measured intelligence, and age-appropriate education.

B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require the composition of written texts (e.g., writing grammatically correct sentences and organized paragraphs).

C. If a sensory deficit is present, the difficulties in writing skills are in excess of those usually associated with it.