Neurocognitive & Neurodevelopmental Disorders
Autism Spectrum Disorder
Autism spectrum disorder is a serious neurodevelopmental disorder that impairs a child’s ability to communicate and interact with others. It also includes restricted repetitive behaviors, interests and activities. These issues cause significant impairment in social, occupational and other areas of functioning.
Autism spectrum disorder (ASD) is now defined by the American Psychiatric Association’s Diagnosis and Statistical Manual of Mental Disorders (DSM-5) as a single disorder that includes disorders that were previously considered separate — autism, Asperger’s syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.
The term “spectrum” in autism spectrum disorder refers to the wide range of symptoms and severity. Although the term “Asperger’s syndrome” is no longer in the DSM, some people still use the term, which is generally thought to be at the mild end of autism spectrum disorder.
The number of children diagnosed with autism spectrum disorder is rising. It’s not clear whether this is due to better detection and reporting or a real increase in the number of cases, or both.
While there is no cure for autism spectrum disorder, intensive, early treatment can make a big difference in the lives of many children.
Autism spectrum disorder impacts how a child perceives and socializes with others, causing problems in crucial areas of development — social interaction, communication and behavior.
Some children show signs of ASD in early infancy. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they’ve already acquired.
Each child with ASD is likely to have a unique pattern of behavior and level of severity — from low functioning to high functioning. Severity is based on social communication impairments and the restrictive and repetitive nature of behaviors, along with how these impact the ability to function.
Because of the unique mixture of symptoms shown in each child, severity level can sometimes be difficult to determine. However, within the range (spectrum) of symptoms, below are some common ASD actions and behaviors.
Social communication and interaction
Fails to respond to his or her name or appears not to hear you at times
Resists cuddling and holding and seems to prefer playing alone — retreats into his or her own world
Has poor eye contact and lacks facial expression
Doesn’t speak or has delayed speech, or may lose previous ability to say words or sentences
Can’t start a conversation or keep one going, or may only start a conversation to make requests or label items
Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
May repeat words or phrases verbatim, but doesn’t understand how to use them
Doesn’t appear to understand simple questions or directions
Doesn’t express emotions or feelings and appears unaware of others’ feelings
Doesn’t point at or bring objects to share interest
Inappropriately approaches a social interaction by being passive, aggressive or disruptive
Patterns of behavior
Performs repetitive movements, such as rocking, spinning or hand-flapping, or may perform activities that could cause harm, such as head-banging
Develops specific routines or rituals and becomes disturbed at the slightest change
May be uncooperative or resistant to change
Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language
May be fascinated by details of an object, such as the spinning wheels of a toy car, but doesn’t understand the “big picture” of the subject
May be unusually sensitive to light, sound and touch, and yet oblivious to pain
Does not engage in imitative or make-believe play
May become fixated on an object or activity with abnormal intensity or focus
May have odd food preferences, such as eating only a few foods, or eating only foods with a certain texture
Most children with ASD are slow to gain knowledge or skills, and some have signs of lower than normal intelligence. Other children with ASD have normal to high intelligence — they learn quickly, yet have trouble communicating and applying what they know in everyday life and adjusting to social situations. A small number of children with ASD are savants — they have exceptional skills in a specific area, such as art, math or music.
As they mature, some children with ASD become more engaged with others and show fewer disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the teen years can bring worse behavioral problems.
An Interdisciplinary Clinical Team Approach
We use a multi-layered treatment approach when treating neurodevelopmental disorders. Patients are treated by an interdisciplinary team of clinicians that includes: a clinical neuropsychologist, a clinical psychologist or behaviorist, a cognitive rehab/speech language therapist and a neuromodulation clinician.
We provide a comprehensive combination of traditional, complementary, as well as, experimental treatments not typically available at any other clinics. For instance, when treating cognitive disorders we typically treat by combining cognitive rehabilitation, with cognitive enhancers, and one or more forms of neuromodulation superimposed on comprehensive behavioral health plan that utilizes specific nutrition requirements, heart-rate variability training, maximizing sleep and the reduction of stress.
Some of these treatments and consultation options include:
Patients admitted to the cognitive rehabilitation program enter a module based on their primary type of cognitive impairment, e.g., the Attention, Working Memory and Executive System impairment module. Each patient will receive specific treatments for this type of cognitive disorder using a combination of remedial, adaptive and compensatory interventions that have been developed at the NeuroCognitive Institute for their module.
We often combine cognitive and language rehabilitation with neuromodulation. Neuromodulation is evolving as a treatment option for treating the cognitive, behavioral and psychiatric symptoms and deficits resulting from neurodevelopmental disorders.
Techniques include invasive procedures such as deep brain stimulation and electroconvulsive therapy (ECT), as well as, non-invasive techniques such as transcranial direct current stimulation tDCS, neurofeedback and rTMS. At NCI, we only use non-invasive neuromodulation intervention combined with other rehabilitation interventions to enhance treatment response.
Speech and Language Therapy
Speech and language therapy focuses on improving speech and abilities to understand and express language.
NCI has speech therapists who can help assess speech delays, restore speech and language skills from young children to adults with neurodevelopmental disorders.
Behavioral Health Interventions
Behavioral health interventions focus on changing or modifying a patient’s lifestyle such as diet and introducing specific exercise programs to enhance cortical and cognitive functioning.
Pharmaceuticals and Nutraceuticals
We use various medications to treat the cognitive, neurobehavioral and neuropsychiatric deficits and symptoms of neurodevelopmental disorders.