Tourette and Learning Impairments

This chapter describes disorders of motor control, language, and learning. Tics are sudden, stereotyped, repetitive, unwanted movements, and a severe form is called Tourette disorder. Their strong association with obsessional disorders and attention deficit hyperactivity disorder (ADHD) is described. Developmental coordination disorder is a group of problems suggesting immaturity in control, both of fine adjustments and of large movements of the limbs. Impairments of language development include receptive, expressive, and pragmatic problems, and can extend to signed language. Problems in learning to read and write and acquire other skills needed for school learning are very frequent in the population. Neuropsychological formulations have been influential in guiding policy and practice in schools. Generalized learning difficulties are conceptualized as intellectual disability.

Psychiatric Consequences of Brain Syndromes

This chapter outlines the nature of common and notable brain disorders that have psychiatric consequences for children and young people. All are often managed by paediatric disciplines in European, Australian, and North American countries. Psychiatrists, however, are often the lead discipline in countries where the medical aspects are considered as less important than the mental. In most countries, physical and mental specialists need to work together with enough understanding of each other’s role that there is no gap in the provision of service. Recognizing multiple morbidity is key. This chapter therefore covers the basics of medical diagnosis and treatment as well as what is known about psychological intervention. Epilepsy, cerebral palsy, hydrocephalus, acquired traumatic injury to the head, localized structural lesions, and endocrine disorders are all described in the chapter. In addition, functional neurological disorders are considered, in order to inform joint diagnostic and therapeutic approaches.

Psychological Interventions

Psychological interventions to promote the quality of life in people with neurodevelopmental difficulties have a range of targets and are not confined to reducing the symptoms. This chapter will describe methods and the trial evidence for them according to their purposes. Explanation and psychoeducation are key methods of helping children, young people, and their families to understand their condition and the limitations it imposes. Symptomatic interventions for tics, hallucinations, impaired impulse control, and disorganization are often applied outside the limitations of single diagnostic categories. Other approaches aim to teach skills to help transdiagnostically with associated problems such as communication difficulties, anxiety, aggression, and self-injury. Yet others aim to alleviate adverse environments, such as isolation from peers, which are encountered by people with any or all of the disorders described in this book. The interventions used include supportive counselling, behavioural techniques, and cognitive methods to create change. Many have been evaluated by controlled trial, and the results will be described as the evidence base to establish which therapies, and for which children, should be priorities for health, education, and care services to provide.

From Altered Function to Restriction of Life

This chapter traces the development of children and young people with neurodevelopmental disorders through their later childhood and teenage years. The pattern and severity of impairments in mental function influence their course over time. In addition, the courses fluctuate in response to a series of encounters with potentially harmful influences. Stigma is widespread in many cultures. Physical illness and injury and premature mortality are consequences of several psychiatric syndromes. Economic disadvantage is more frequent for families of disabled people and interacts with other family stresses. Transitions into school, peer cultures, puberty, work, and the virtual world of the internet all tend to take different forms for those whose brain functions are altered by comparison with the rest of the population. All these can be responsible for adverse outcomes of children and young people.

Autism Spectrum Disorder and Early-Onset Psychoses

This chapter covers the profiles of difficulties in relating, to other people and the world, that are included in the international schemes of classification as spectra of autism, schizophrenia, and psychosis. In autism, there is a marked reduction in, or oddity of, social communication, and an increase of repetitive and stereotyped behaviours. In psychoses, including schizophrenia and catatonia, there is disordered testing of reality (resulting in hallucinations, delusions, and disorganized speech), and deficits in volition (involving apathy, social isolation, and lack of initiative). These are described as they present in children and young people, together with their prevalence and the coexistent problems of emotion and behaviour that occur frequently. The longitudinal course is considered up to the transition into adult life. Potential causes and pathophysiology are considered in so far as they apply specifically to these disorders.

Scope and Principles of Neuropsychiatry in the Young

This chapter introduces the concept of neurodevelopmental disorders, a group of conditions characterized by onset in early childhood, persistence into adult life, and high rates of altered cognitive and neurological function. Genetic influences are strong and male gender predominates. Such disorders are frequent reasons for referral to psychiatry, paediatrics, and clinical psychology and often require team approaches to meet a variety of needs for service. They used to be regarded as distinct categories of disturbance, but a modern understanding has established them as common conditions, frequently present together and having continuous distribution in the population. Attention disorders, the spectrum of autism, intellectual and learning deficits, language disorders, and abnormalities of movement all figure and commonly account for difficulties in education and the development of problems in personal relationships.

Drug Treatments

This chapter describes the use of medication in alleviating the problems of young people with neurodevelopmental disorders. It gives special emphasis to its use in multiple overlapping conditions and to the long-term impact on functioning. Stimulant and non-stimulant medications for the control of inattention and hyperactivity are reviewed. Antipsychotics for control of agitation and aggression, as well as for the treatment of psychosis, are considered. Pharmacological management of mood and anxiety problems is covered in the context of people with neurodevelopmental disorders. Control of tics, other movement disorders, and sleep problems are included. Practical considerations of prescribing are covered, and cautions about safety include descriptions of adverse events and how to reduce them.

Attention Deficit Hyperactivity Disorder

This chapter describes the recognition and associations of the syndrome of attention deficit hyperactivity disorder (ADHD), with special reference to the multitude of associated problems. Inattentiveness, overactivity, and impulsiveness are behaviour styles that predict later disadvantage in education, employment, physical health, substance use, mental health, and personal relationships. They very often coexist with features of oppositional disorders, anxiety, and the autism spectrum. These are considered both as differential diagnoses and as multiple morbidities needing to be recognized. Several cognitive limitations, including in executive function, can be identified by psychological testing. Genetic inheritance is a powerful influence. Neuroimaging is detecting an increasing number of changes in brain structure and function. The problems are widespread, but recognition of the syndrome varies between countries. The diagnosis is increasing in frequency over time. Treatment with stimulant medication is often helpful, but there is considerable controversy about how widely to apply it.

Genetic and Environmental Influences on Early Development

This chapter considers the genetic and environmental influences that may lead to the appearance of neurodevelopmental changes in early life. Behavioural genetics considers similarities between individuals in the light of their degree of biological relatedness, and has established high levels of heritability for several problems. Molecular genetics has therefore progressed to identifying individual genes. Single environmental risk factors can be identified and aggregated into a concept of adversity. Defined chromosome and single-gene changes are described for conditions such as Down and fragile-X. They emphasize the power and the complexity of genetic influences. Most complex psychiatric disorders are the result of large numbers of genes of small effect considered individually, but large effect in interactions with each other and with the environment. Environmental influences are considered in this chapter both from the perspectives of gene–environment correlation and interaction, and as known associations that can be causes. Infections, toxins, and deficiencies are described. Challenges from psychosocial adversity are included, together with their possible modes of action.

Development and Pathology of Key Functions

This chapter will describe some key functions that are vulnerable to genetic and environmental changes affecting the brain. Motor function, attention, memory, executive function, communication, social understanding and empathy, reality testing, and emotional regulation will be considered separately. Their typical development and the consequences of alterations for psychopathology will be described as the basis for understanding the complex and overlapping results of brain dysfunctions. The brain substrates for such functions are outlined. None of them is a unitary process. They have complex and developing relationships with the diagnoses of attention deficit, autism, language, coordination, learning, and tic disorders. All of them have significant roles to play beyond diagnoses in the development of children and young people.