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Other Neuropsychological Disorders in Children: Go to Treatment Options
Children can be diagnosed with a wide variety of neuropsychological disorders other than
autism. Some of the syndromes are very rare. I have seen a case of Transit Hemiplegia of Childhood, which in only thought to affect around a hundred children in the world, and a case of Aarskog Syndrome, which also affects around a hundred children worldwide. Somewhere between six and seven thousnd genetic disorders and inborn errors of metabolism have been documented in children. Below are some of the neuropsychological disorders that present at my clinic. TheNational Organization of Rare Disorders (NORD) has information on the disorders below as well as countless more.
1. Fragile X Syndrome
2. Mental Retardation
3. Learning Disorders
4. Language Delays
5. Willams Syndrome
6. Attention-Deficit-Hyperactivity-Disorder
7. Feeding and Eating Disorders of Infancy or Early Childhood
8. Tic Disorders including Tourette's Disorder
9. Elimination Disorders
10. Separation Anxiety Disorder
11. Selective Mutism
12. Fetal Alchol Syndrome
13. Crack Babies
14. Failure to Thrive Syndrome
15. Down Syndrome
16. Traumatic Brain Injury
17. Shaken Baby Syndrome
18. Cerebral Palsy
19. Lesch-Nyman Syndrome
20. Prader-Willi Syndrome
21. Angelman Syndrome
22. Tuberous Sclerosis
23. Sleep Disorders
Most children with neuropsychological disorders have compliance problems when they first come in and parents and
often caregivers do not know which behaviors are related to the syndromes above and
which behaviors are simply noncompliant behaviors. In order to deal with the behaviors
related to the syndromes it is necessary to first manage the behaviors having to do with
compliance, as we do with autism. If the child does not follow directions we must
determine if it is related to the particular syndrome the child has or the child has simply not
learned to follow directions. The first ABA programs we run in our clinic almost always
have to do with compliance issues, such as following directions consistently, and
eliminating behaviors that interfere with compliance such as tantrums, aggressive
behavior, or self-injurious behavior. No matter what your child's diagnosis is the programs
in the ABA eBook for compliance should be run first. Then ABA programs dealing with
specific problems such as attention deficits, etc., should then be implemented.
Descriptions of Neuropsychological Disorders in Children:
1. Fragile X Syndrome
The most frequently occurring cause of mental retardation, Fragile X affects approximately
1 in 2500 females and 1 in 1200 males. Physical characteristics include larger than
average forehead, hands, and ears, perseverations in speech, and hyper-extendible
joints. Exclusive to males with this disorder are abnormally large testes.
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2. Mental Retardation
Mental retardation is most easily defined as low intellectual functioning. IQ scores should
be at 70 or below. Those with mental retardation are often unable to perform tasks that
others in the same age group are able to perform. Deficiencies of this type must be
present in at least two of the following areas: communication, self-care, social skills, self-
direction, work, leisure, and safety.
Causes of mental retardation can be prenatal (i.e. malnutrition of the mother), perinatal (i.
e. prematurity of the child), or postnatal (i.e. head trauma).
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3. Learning Disorders:
A. Dyslexia
Dyslexia is the most common learning disorder, occurring in approximately 3-6% of all
children. Characteristics of dyslexia include difficulty in regard to single-word decoding,
writing and spelling, communication, and comprehension. Those with dyslexia may also
possess negative views of themselves, and may have co-occurrences of attention deficit
disorder, conduct disorder, or oppositional defiant disorder. Dyslexia can be caused by
neuroanatomical (physical) disorders.
B. Dyspraxia/Apraxia and "Clumsy Child"
These disorders may occur with dyslexia, and are exclusively physical in nature.
C. Fine Motor Deficit
This deficit can best be explained as a difference of 25% of more in the development of
fine motor skills compared with gross motor skills, adaptive social skills, and/or language
skills. Often, children with this disorder will display tremors of dyspraxia. Children with
fine motor impairment are often male and have high rates of behavior disorders and
seizures.
D. Disorder of Written _Expression
This disorder is diagnosed when there exists large differences among standardized
assessments of IQ, age, and level of education. Those in primary grades often experience
deficits in orthographic motor integration, whereas those in intermediate grades more
often display deficits in verbal working memory and expressive language ability. Lastly,
those in college or late high school display deficits in higher cognitive processes, such as
the planning of intricate tasks.
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4. Language Delays
Causes of language delays can range from physical to psychological problems. Among
these specific problems are mental retardation, structural anomalies (i.e. a cleft palate),
learning disabilities, autism, brain lesions, deafness, cerebral palsy, head trauma, and
tumors.
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5. Williams Syndrome
Occurring in approximately 1 in 25000 to 1 in 50000 live births, Williams Syndrome includes
physical abnormalities such as depression in one's nasal bridge, deep and raspy speaking
voice, smaller than average ears, and thicker than average lips. Also occurring in patients
with the disorder are low birth weight, difficulty in feeding, difficulty in gaining weight,
vomiting, constipation, irritability, and more rarely, hyperglycemia. Those with Williams
Syndrome often have an early developmental delay, and are highly subject to below
average IQ (often having mild to moderate mental retardation). Personality characteristics
of those with the disorder include friendliness, talkativeness, and politeness. Also,
extreme anxiety and sensitivity to loud noises is prevalent in Williams Syndrome. Initially,
during preschool years, motor skills and language are delayed, but between the ages of
10-18 years, language skills dramatically improve.
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6. Attention-Deficit-Hyperactivity-Disorder
Inattention: Those with ADHD often make careless mistakes because of their inattention
to the task they are attempting to complete. Often, a child with ADHD will appear
disregard whatever is being spoken by someone else, and is also often forgetful. The child
with ADHD is easily distracted.
Hyperactivity: Often, the child will appear to be fidgety, restless, and extremely talkative.
Impulsivity: Often the child with ADHD will display much impulsivity, such as interrupting
someone else when he/she is speaking, or having difficulty awaiting their turn when it is
appropriate.
In addition to genetic traits influencing the occurrence of ADHD, other factors influencing
ADHD include complications during a mother's pregnancy and childbirth, low birth weight,
and prenatal substance abuse by the mother.
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7. Feeding and Eating Disorders
Causes usually include social, cultural, physical, and psychological influences.
A. Anorexia Nervosa: In this disorder, body weight is almost exclusively below average.
Anorexia occurs mostly in females, but can occur in males, though rare. Onset of the
disorder is usually 18 years, and abnormal thoughts and perceptions concerning body
image are evident. Co-occurences of depression and anxiety are common in anorexic
patients.
B. Bulimia Nervosa: Bulimia nervosa is characterized by recurrent bing-eating and
compensatory behaviors in order to maintain body weight. These behaviors must occur at
least twice a week over at least a 3-month period in order to be diagnosable. Bulimia
nervosa can be either purge type or non-purge type, dependent on whether or not self-
induced vomiting or defecation occurs. Most with bulimia are females, and bulimia may co-
occur with depression, substance abuse, and/or anxiety.
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8. Tic Disorders including Tourette Disorder
Tics are always brief and rapid movements or sounds, ranging from repetitive eyeblinking,
facial grimaces, or throat clearing, though tics are certainly not limited to the
aforementioned. Tic disorders often occur before the age of 18 years, and exist for at
least 12 months.
Tourette's Syndrome affects approximately 5 in 10000 people, and these patients often
have problems with mood stability, impulse control, anxiety, attention, and learning.
Common co-occurrences of Tourette's Syndrome include ADHD and Obsessive-Compulsive
Disorder. The average onset for tic disorders is normally 7 years, and are mostly limited to
eyeblinking, followed by bodily shrugs , and eventually develops into verbal tics. Causes
of tic disorders have a physical basis.
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9. Elimination Disorders
A. Enuresis is the involuntary discharge of urine that can occur at night or day. In order to
be diagnosable, the child must be over the age of 5 years and has experienced symptoms
for at least twice a week for a minimum of 3 months. This disorder is more common in boys
than girls, and urine is involuntarily discharged more frequently at night than during the
day. Causes of enuresis are mostly physical, though in diurnal enuresis, causes can be
social.
B. Encopresis is described as defecation in inappropriate places after the age of 4 in
children. This disorder can occur with or without constipation or overflow incontinence.
Encopresis occurs in approximately 1.5-3% of children over the age of 4, but should decline
relatively quickly as the child ages. This disorder is more common in boys than girls, and
causes are often physical.
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10. Separation Anxiety Disorder
Beginning at approximately 9 months of age, Separation Anxiety Disorder has 2 major
characteristics including the realization that the primary caregiver is not present, and the
realization of powerlessness without the primary caregiver. Separation anxiety disorder
begins to decline by 18 months of age.
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11. Selective Mutism
Children with this disorder often refuse to speak in social situations, in which
communication is often expected. This disorder is basically seen as the equivalent of social
anxiety manifested in adults. Children with selective mutism simply refuse to speak for
reasons including anxiety, not inability. Cognitive behavioral therapy is often utilized for
treatment of selective mutism.
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12. Fetal Alcohol Syndrome
Occurring in approximately 1-2 in 1,000 live births and 2-10% of babies of alcoholic
mothers, features of FAS include facial deformities, other physical abnormalities,
intrauterine growth retardation, developmental delays, deficits in attention, hyperactivity,
and disabilities in learning.
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13. "Crack Babies"
Recreational drugs taken during pregnancy effect the fetus. Crack cocaine and other drugs
cause behavior problems which are usually ADHD type of behavior. The time during
pregnancy that drugs are taken as well as frequency and amount of drug use are related
to severity. Babies exposed to a mother's marijuana use during pregnancy can display
such characteristics as decreased visual responsiveness, tremors, increased startle
response, and alterations in sleep patterns after birth.
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14. Failure to Thrive Syndrome
Major features of this syndrome include especially low weight. Weight must be below the
5th percentile according to age, and an actual deceleration in weight gain from birth to the
child's present age. This syndrome is related to issues regarding nurture of the child by
the family: low caregiver-child attachment, poverty, family dysfunction, and lack of social
support. This syndrome can be fatal if a change in environmental conditions does not
change.
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15. Down Syndrome
Also known as "Trisomy 21," Down syndrome is the most frequently occurring genetic
mental retardation syndrome. Occurring in about 1 in 660 live births, Down syndrome
rates are higher for very young mothers and mother who are over the age of 40 years.
Shortness in physical height, large tongue, upward tilted palpebral fissures, epicanthal
folds, small ears, short yet large hands, and hyper-extendible joints are all characteristics
of the syndrome, though others can be present. In approximately 94% of cases of Down
syndrome, the cause is de novo trisomy of chromosome 21. A prevalent neurophysical
characteristic of Down syndrome includes a deceleration in brain growth during infancy.
Those with this syndrome learn much more slowly than those without the syndrome, and
are at increased risk of dementia earlier in life.
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16. Traumatic Brain Injury
Classified as physical damage or impairment of the brain. Often, this does not include
injury resulting from trauma during birth, poisoning, asphyxia, facial and scalp injuries, or
skull fractures that are not depressed. Open traumatic head injury occurs when the skull
has been penetrated, whereas closed traumatic head injury occurs when there is rapid
acceleration or deceleration, such as that in a car accident. Causes of this disorder in
infants are usually the result of abuse, while causes during preschool age are attributed to
falls. The most common cause of traumatic brain injuries during early elementary years is
accidents involving pedestrians, and during later childhood years, the major cause is
bicycle and sports accidents. After the age of 14 years, the major cause of injury is vehicle
accidents.
Poverty, households headed by single parents, parental history of psychiatric disorders,
alcohol and drug use, unsupervised play, and difficulties associated with learning,
cognitions, and behavior are considered risk factors for traumatic brain disorder.
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17. Shaken Baby Syndrome
Syndrome characterized by acute subdural hematoma and retinal hemorrhages. Common
results of severe shaking of an infant are apnea and hypoxia. Medical attention must be
sought after injury, or secondary damage may occur, especially if the infant is immediately
put to sleep by a caregiver.
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18. Cerebral Palsy
Divided into categories according to level of severity: spastic diplegia-some deficiency in
movement is evident; spastic tetraplegia-few spontaneous movements, severe feeding
difficulties; and spastic paraplegia-no movement. Cerebral palsy is caused by a collection
of cerebral lesions, causing motor deficits. Correlated with cerebral palsy is low intellectual
functioning and often, mental retardation. Also, co-occurring with cerebral palsy are
depression, low self-esteem, autism, and hallucinations.
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19. Lesch-Nyman Syndrome
X-linked recessive disorder predominantly occurring in males. This syndrome is considered
rare, occurring only 1 in 10,000 to 1 in 380,000 live births. The cause of this syndrome is
due to an absence of the enzyme HPRT, essential in purine metabolism. Infants with this
syndrome are often irritable, have problems with feeding, have delayed motor
developments, and have unusually low physical weights and heights. Self-injurious
behaviors are also typical of Lesch-Nyman Syndrome. Death often occurs in adulthood as
a result of infection or renal failure. Depression and suicidal thoughts are also associated
with this syndrome, though these symptoms can successfully be treated with
antidepressant drugs.
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20.Prader-Willi Syndrome
Disorder affecting both children and elderly populations. This syndrome occurs in between
1 in 10,000 to 1 in 25,000 people, and possesses no racial or gender preferences. Infants
exhibiting the syndrome have symptoms including below average weight and are
sometimes hypotonic. In childhood, symptoms include overeating and obesity. Physical
characteristics include narrow palpebral fissures, high mid-face, large and high chin, and
broad and low-set ears. Often, young children with the syndrome are considered to be
kind and charming, though later in life, adults with the syndrome are prone to irritability
and aggressiveness.
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21. Angelman Syndrome
Caused by the deletion of maternal 15q12 chromosome, this syndrome is classified by
severe mental retardation and seizures.
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22. Tuberous Sclerosis
Inherited disorder of cellular differentiation and proliferation occurring on two genes.
Genetic mutations are a common cause of tuberous sclerosis. Physical characteristics
include, but are not limited to, skin lesions, retinal lesions, seizures, mental retardation,
and less commonly autism and sleep disturbances. Diagnosis is dependent on three levels
of criteria, including primary, secondary, and tertiary features. Diagnosis is also classified
into levels of definite tuberous sclerosis, probable tuberous sclerosis, and suspect
tuberous sclerosis.
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23. Sleep Disorders
Two major categories for sleep disorders: parasomnias (intrusion during sleep) and
dyssomnias (intrusion while attempting to initiate and maintain sleep).
Nightmares, sleep walking, sleep talking, night terrors, and partial arousals are
characteristic of sleep disorders. Anxiety and fear can affect sleeping patterns. Enuresis
(bed-wetting) is a fairly common occurrence caused by familial factors, small bladder
capacity, weak urethral sphincter, and varied response to bladder contractions. Some
children may repeatedly bang their heads against things in order to get to sleep. Night
seizures can occur, but are rare. Other problems in sleeping include hypersomnia,
narcolepsy, disorders related to breathing, and disorders related to one's circadian rhythm.
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