Developmental Disorders

• Developmental disorders are lifelong disabilities due to mental and/or physical impairments. These impairments can be in one or more of the following areas:
  • Understanding verbal and non-verbal (body language) communication.
  • Making and keeping friends.
  • Learning basic life skills.
  • Expressing their own emotions.
  • Reading others’ emotions.

• Autism Spectrum Disorder (ASD) is a common developmental disorder that covers a wide range of issues a person may experience within two domains:
  1. Issues with social communication and interaction, such as:
     • Lack of interest in socializing with others.
     • Difficulty understanding and following social rules (e.g., talking out of turn, understanding humor and sarcasm, personal space, and inappropriate information sharing).
     • Difficulty with verbally communication.
  2. Restricted, repetitive behaviors, interests, and/or activities, such as:
     • Repeating phrases or words.
     • Tapping or spinning objects.
     • Ritualized behaviors (e.g., taking the same route or eating the same foods on a daily basis).
     • Unusually high sensitivity (hypersensitivity) or unusually low sensitivity (hyposensitivity) to visuals, light, sound, touch, taste, and/or smells. Responses to seemingly normal stimuli may be experienced as painful, unpleasant, or confusing.
       • Examples of hypersensitivity : being unable to tolerate certain clothing materials, being touched, or being in a room with normal lights.
       • Exaamples of hyposensitivity : staring at bright lights, not being bothered by loud sounds, or not responding when called by name.

Symptoms within both domains must be present. However, each individual's symptoms may vary, and some autistic people may have more trouble in one area than another. In most (but not all) cases, symptoms become noticeable before the age of 3. In addition, autistic people may or may not have an intellectual disability. It is important to identify and focus on their personal strengths.

A lot of people wonder how to refer to people who have been diagnosed with ASD. While some people prefer to say "a person with autism" (this is called person-first language), most autistic adults prefer to be called "an autistic person" and will say "autistics" when referencing more than one person with autism. It's best to use "autistic" instead of "person with autism" unless the client asks you to use person-first language.

• People with developmental disorders may have limitations in some of the following areas:
  • Self-help and self-care.
  • Language use and comprehension.
  • Learning.
  • Mobility and coordination.
  • Self-direction.
  • Capacity for independent living.
  • Ability to function independently.
• A person with disabilities may, with education about life skills, be able to live independently or in supported living.
• Whenever possible, adapt the environment or task to the person's abilities.
• Be considerate of cultural and environmental factors.
• PDDs are diagnosed more frequently in boys than girls.
• There can be much stigma associated with developmental disorders. Reassure caregivers that they did not cause developmental issues.
• Children with developmental issues are more likely to experience child abuse and neglect.
  • Supporting and educating the child and family can reduce this risk.
  • If you suspect the child is being abused or neglected, see Chapter D-3: Abuse and Neglect.
• Developmental disorders often overlap with other disorders, such as:
  • Anxiety (See Chapter D-9: Anxiety and Worry ).
  • Depression (See Chapter D-8: Mood Disorders (Depression & Bipolar) ).
  • Attention Deficit Hyperactivity Disorder (See Chapter D-13: Hyperactivity and Problems with Attention ).
  • Conduct problems (See Chapter D-25: Conduct Problems in Children and Youth or Chapter D-26: Conduct Disorder ).
  • Learning Disorders (See Chapter D-11: Learning and Cognitive Disorders ).
• Symptoms of developmental disorders often become apparent in childhood.
  • People with developmental disorders are often first diagnosed in childhood.
  • Individuals who are diagnosed as adults typically have a history of symptoms that began in childhood.
  • Intervention often involves working with others, such school staff who are implementing an IEP or 504 or people providing behavior therapy and life skills training.
  • Children with developmental disorders will benefit from individually planned and coordinated services and supports.
  • Children who are diagnosed early and receive early intervention typically have significantly better lifelong outcomes.
• There are no medications that can cure pervasive developmental delays. However, some medications may help reduce symptoms of co-occurring disorders. For example, an autistic person who also has ADHD and anxiety may make more progress in behavioral therapy if the attention and anxiety issues are appropriately treated.

Referral information, including reports from medical providers, school staff, clinicians, employersr, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history particularly related to development and social abilities. Review the medical chart to see when the last well-child check or physical occurred and if any major milestones have been missed or are delayed.

Treatment Plan, including a history of presenting problem and recommended course of treatment. Review the DSM-5 for criteria on Pervasive Developmental Disorders.

Review Chapter C-1: Development Across the Lifespan to understand typical development.

General areas of concern:

• Poor social skills
• Limited communication skills
• Unusual behaviors or interests
• Limited emotional expression

Social skills:

• Has trouble understanding other people’s feelings or talking about her own feelings
• Prefers not to be held or cuddled, or might cuddle much less than peers
• Is too cuddly or physical with others, such as people she doesn't know well or people who are expressing that they don't want to be touched at the moment
• Withdraws from social settings or prefers to be alone
• Appears to be unaware when other people talk to her, but reacts to other sounds
• Appears interested in other people, but uncertain of how to interact
• Has a hard time making or keeping friends
• Seems nervous in large social groups
• Does not engage in pretend play or does so less or much later than her peers (e.g., does not play house or use one object to represent an imaginary other object)
• Is inflexible about what to play or about the rules

Communication skills:

• Avoids eye contact (not related to cultural practices)
• Has difficulty understanding body language
• Has trouble expressing his needs using typical words or motions
• Repeats or echoes words or phrases said to him or from movies, or repeats words or phrases in place of conversational language
• Talks only about himself and his interests

Emotional expression:

• Has difficulty understanding others' feelings
• Does not share or express a range of feelings
• Responds negatively to changes in her routine, environment, or daily plans
• Appears to overreact to things others might find a little frustrating

Unusual behaviors:

• Has rituals that he refuses to change
• Develops odd or repetitive movements
• Has unusual reactions to the way things smell, taste, look, feel, or sound
• Speaks in different ways or with a different tone than peers
• Does not look at objects when another person points to them
• Has narrow, sometimes obsessive, interests
• Loses skills he once had (for example, stops using words he knows)
• Does not show interest in people or objects in his environment
• Is clumsy or moves awkwardly

General concerns

• What concerns do your parents, family members, school, work, medical providers, or others have?
• Have you ever had a concussion in the past?
• Has anyone in your family ever been diagnosed with a:
  • Developmental disorder
  • Learning disorder
  • Genetic or chromosomal disorder

Birth–12 months old. Does the baby have:

• Low or no interest in other people
• Lack of or infrequent eye contact

12–24 months old. Does the toddler have:

• Deficits in language development
• Lack of imaginative play
• Delays in motor development

2–4 years old. Does the child:

• Have deficits in language development
• Plays alongside or separately from other children, but not with them
• Have delays in fine motor sills
• Have trouble accepting or expressing affection, or act overly affectionate when not appropriate for the situation

4–6 years old. Does the child have:

• Trouble understanding or appropriately responding to nonverbal signals from others
• Less flexibility than peers about playing by others' rules
• Different interactions with others than peers do
• Inflexibility with routines and rules

7–12 years old. Does the child have:

• Trouble playing cooperatively with peers
• Difficulty seeing things from others' point of view
• A need for social rules and roles spelled out and trouble understanding theem

12–18 years old. Does the youth have:

• Deficits in abstract thinking stills
• Difficulty fitting into social groups
• Trouble understanding or displaying appropriate social behavior

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, treatment plans for individuals with developmental disorders may focus on issues related to the following:

• Increasing language and the ability to communicate (verbally and nonverbally).
• Developing social skills focused on making and keeping friendships, or learning strategies to interact with people in public.
• Learning and practicing day-to-day activities related to general health and happiness.
• Developing coping strategies to manage situations that may be overwhelming or overstimulating.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.