Neurodevelopmental disorders- what to look out for

By max Davie: PMHA convenor

This is a version of the talk I gave last week to the Primary care and pubic health conference at the NEC Birmingham. The main purpose of this post is to reinforce some of the messages in that talk to delegates, and help with signposting to other resources. It may also be of interest to other professionals curious about these conditions.

Professionals and parents are increasingly aware that children are being diagnosed with developmental disorders, but it’s not always clear what these are, or how to spot them. My aim is to help with this.

The term neurodevelopmental disorders is often confusingly defined. For me this is a group of inter-related patterns of abnormal neurodevelopment, which show themselves in characteristic patterns of behaviour, and lead to functional impairment in the child. Put another way, these are just patterns of dysfunction that more or less cluster around certain diagnostic terms.

This piece is not about the causative pathways that lead to these conditions, nor about the anatomical, physiological or genetic correlates, but about spotting and differentiating these patterns, in order to inform intervention.

I’ll try to cover ASD, ADHD, DCD, and a few other topics. Basically, when I run out of energy, I’ll stop.

Continue reading “Neurodevelopmental disorders- what to look out for”

New review in Archives on autonomic nervous system

http://m.adc.bmj.com/content/early/2014/02/26/archdischild-2012-301863.full

This (paywalled) article on the archives website, by Corinne Rees, raises interesting questions about the role of autonomic dysfunction in functional disorders, in mediating anxiety, and in sustaining the link between early adverse experience and later psychopathology.
The problem is the authors obvious emotional investment in the importance of the ANS. It reads like an opinion piece, not a careful review of the evidence. There’s passionate advocacy of the ANS’s importance, but little discussion of the fact that it’s dysfunction could have other causes itself, be they physical or psychological. Indeed, the fact that the ANS is so difficult to define is not mentioned. Finally, although patient and parent reports are of course important, to reproduce these reports uncritically in a  review article, without research corroboration, may raise a few eyebrows.
Nonetheless, this is an essential read, whether you 100% agree or not.

Sleep Interference Effects of Pathological Electronic Media Use during Adolescence – Online First – Springer

http://link.springer.com/article/10.1007/s11469-013-9461-2#
This is a weird paper. They have some good data on the prevalence of poor sleep in adolescence, and also on electronic media use. They make a plausible link between media use at bedtime and delayed sleep initiation. So far, so sound.
they then import the notion of pathological media use, which they define as use which is unregulated and affects daily activities. This is diagnosed on parent report, which seems to import all sorts of subjective judgments into this category, which not, as as I’m aware, validated.
They then draw a causal link between pathological media use and the poor sleep quality. To an extent this is sensible- using electronic media at bedtime will delay sleep, but the problem is that they don’t consider why the media use has become pathological… Is the a population of young people seeking respite from mental health or family problems, having their phones blamed for their problems, when perhaps a more understanding attitude, exploring what has gone wrong for this person and their sleep, might be more helpful.