Understanding Pediatric Neurodevelopmental Disorders

Autism spectrum disorder (ASD) is classified as one type of neurodevelopmental disorder. More predominant in males, ASD occurs early in childhood, impacting language, communication, and social interactions. Autistic persons may experience sensory overload, the need for routine and predictability, verbal and nonverbal communication difficulties, and social interaction problems (Hodis et al, 2025). ASD red flags can include (Hodis et al., 2025):

• Eye contact avoidance
• Delayed speech
• Repetitive motions (stimming)
• Not meeting childhood milestones like pointing to objects by 14 months of age.

Please see the following image for other signs and symptoms of ASD in children.

Image 1:
Signs of Autism

(*Please click on the image above to enlarge.)

It is important to be able to recognize the signs of ASD in children. Often, 40% of children experiencing ASD can show both aggression and self-injurious behavior (Edelson, 2022). Aggressive behavior that can be demonstrated can include (Edelson, 2022):

• Face slapping
• Head banging
• Hair pulling
• Excessive scratching that can vary in duration and severity

Self-injurious behaviors can also be seen with tissue damage that is non-lethal and self-inflicted (Sawant et al, 2023). It is theorized that this behavior occurs due to the impairment in language and communication and the reduced capacity to understand the environmental stimulation (Sawant et al, 2023).

Screening for ASD is recommended at 18 and 24 months of age.

Please review the following examples of screening tools that are available to help identify possible ASD in a child (American Academy of Pediatrics [AAP], 2025). This list is not exhaustive.

• Modified Checklist for Autism in Toddlers-R/F (M-CHAT-R/F) : This tool is available in multiple languages, is a two-part screener with parents doing the first part and the provider completing the second part. The tool is free for use, takes 10 minutes to complete, and is used on children ages 16-30 months.
• The Survey of Well-Being of Young Children (SWYC): Parent's Observations of Social Interactions (POSI): This tool is a 6-item parent-completed screening tool, performed on children ages 16-35 months, available in multiple languages. It takes 15 minutes or less to complete.
• Screening Tool for Autism in Toddlers and Young Children (STAT): This tool is available in English only, performed on children ages 24 to 35 months, and is a provider completed questionnaire that takes approximately 30 minutes.
• Social Communication Questionnaire (SCQ) : This tool is available in multiple languages, is used in children over the age of 4, has 40 yes/no questions that are in the form of parent checklists, and must be scored by a developmental professional. It takes less than 10 minutes to complete.

You can learn more about each of these and find others by visiting the American Academy of Pediatrics’ (AAP) screening tool finder at this link.

Early identification and screening for ASD is vital to start intervention services. The earlier that ASD is identified, the sooner interventions and services can begin to benefit the child and their development (CDC, 2025b). According to Hodis et al. (2025), there are 28 evidence-based interventions that can be provided for optimal treatment. These interventions address 13 different outcomes including behavioral, cognitive, sensory and music integration, and augmentative-based treatments incorporating social play and outcomes (Hume et al., 2021; Hodis et al, 2025).

A few examples of these 28 evidence-based interventions include (Hume et al., 2021; Hodis et al, 2025):

• Antecedent-based interventions where a situation is set up to increase the occurrence of a behavior to work towards reducing these behaviors in the future
• Augmentive-based interventions where alternative modes of communication are utilized rather than verbal conversation
• Exercise and movement interventions that use physical exertion and motor skill techniques to work on behavior and skill achievement

To review the list of 28 in their entirety, feel free to review the entire research article by Hume et al. (2021) at the original publication link.

No pharmacological interventions are recommended currently unless to treat the underlying behaviors that may occur like depression, anxiety, or ADHD symptoms. Jiang et al. (2022) explains that nonpharmacological interventions like music therapy, yoga, massage, acupuncture can be very helpful.

Attention deficit hyperactivity disorder (ADHD) is linked to low levels of dopamine and noradrenaline interactions in the prefrontal cortex and the basal ganglia. ADHD is estimated to impact between 5.9 to 7.1% of children and adolescents in the world (Razzak et al, 2021). ADHD is considered to be a condition that starts in children but can progress later in life. It is 3 times more common in males (Williams et al, 2023).

Diagnosis is made utilizing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition text revision (DSM-V-TR) criteria (American Psychiatric Association [APA], 2022). To meet criteria, symptoms must last more than 6 months in which executive dysfunction, hyperactivity, and/or inattentiveness occur in both the school and the home environment, or otherwise two separate locations (Magnus et al, 2023; Razzak et al, 2021).

Williams et al. (2023) notes that, in the prenatal and perinatal time period, risk factors that have been associated with ADHD include:

• Prematurity
• Low birth weight
• Maternal smoking history
• Stress
• Trauma
• Obesity

It is important to evaluate the child with a patient-centered, comprehensive assessment. The evaluation should include the child, the parent, the teachers, and even the school psychologist. Asking about core symptoms and behaviors is vital to understanding how the child interacts at home and at school.

Asking detailed questions on the core symptoms of attention deficit should occur with questions on the following:

• What age did the symptoms first occur?
• When do the symptoms occur?
• What are the specific symptoms and behaviors that you are seeing?
• Where/in what setting do the symptoms occur?
• Does anything help the symptoms?
• What has been tried to alleviate the symptoms?
• Do the symptoms interfere with school and daily activities and interactions?

As was just mentioned, the DSM-5-TR (2022) criteria for ADHD require the problem to be present for at least 6 months. The criteria also require that the child has at least six symptoms and that these symptoms start before the age of 12. Common symptoms of ADHD include the following (APA, 2022):

• Does not pay attention to detail
• Does not listen in conversation
• Interrupts conversation or butts into a conversation
• Often does not follow through on instructions
• Often fails to finish schoolwork, chores, or duties in the workplace because they lose focus or become sidetracked
• Difficulty organizing activities and tasks
• Dislikes and avoids tasks that require mental effort
• Misplaces items 
• Does not sit still
• Frequently moves around, is restless, and fidgety
• Forgetful in common daily activities
• Makes careless mistakes
• Is often forgetful
• Unable to wait their turn
• Frequently acts and speaks without thinking
• Calls out answers before the question is complete
• Frequently interrupts others

Image 2:
Three Core Symptom Categories of ADHD

1. Predominantly Inattentive Type
2. Predominantly Hyperactive-Impulsive Type
3. Combined Type

The symptoms listed above, if reported, are what decide which type of ADHD the child has. Another important thing to remember is that the DSM-5-TR criteria also require that the symptoms interfere with or affect daily functioning of the child, in order for it to be at the level of a disorder (APA, 2022).

Some of the common screening tools to help in the assessment of ADHD include the following:

• The NICHQ Vanderbilt Assessment Scale for Parent and Teacher: This tool evaluates 18 of the core ADHD symptoms in addition to performance and assessment elements (AAP, 2002).
• The Conners ADHD Rating Scale: This tool is a self-reported rating that is used in children 11-17 to assess for potential ADHD. The domains assessed include aggression, attention problems, hyperactivity, executive function, cognition, and social interaction (Conners, 2001).
• The Conners Comprehensive Behavior Rating Scale, or Conners CBRS: This tool tests children’s behavior from age 6 to 18. There is a short (Conners Clinical Index) composed of 25 questions and takes 5-10 minutes to administer. The long version of Conners CBRS assessment takes approximately 90 minutes to complete (Conners, 2001).

A comprehensive treatment approach with interdisciplinary collaboration is recommended to effectively manage ADHD. The provider should gather a detailed family and child personal history. Gather information from the educational setting on behaviors and school performance.

Providing education to the parent or caregiver on the disorder and potential causes is vital. Recommendations for behavioral therapy, parent training classes, and providing parent and child coping skills are important to share as well. Coordination with the school setting on educational plans like individualized education program (IEPs) plans or 504 plans is highly recommended to help contribute to student success. For all children with ADHD who attend school, the school must be involved in the treatment plan (CDC, 2024a). Performing screening and making decisions on pharmacological treatment is important as well.

First-line treatment recommendations for ADHD are stimulants with a success rate of 70% (CDC, 2024b). Stimulant medications are amphetamines like methylphenidate and dextroamphetamine. Amphetamines, in general, act by inducing catecholamines to improve cognition and increase energy. Methylphenidate works by blocking the reuptake of dopamine and norepinephrine, thereby increasing the levels of these neurotransmitters in the brain.

Monitoring for side effects is required due to adverse effects on reducing appetite which may impact weight and on the cardiovascular system with electrocardiogram (EKG) abnormalities and potential QT-prolongation (Farzam et al., 2023). Monitoring for abuse potential of stimulants which are controlled substances like methylphenidate should also be a consideration. Avoidance of stimulants is indicated if there is a significant cardiac history or eating disorder in which nutritional deficiencies have been identified.

Non-stimulants like atomoxetine are also indicated as options for treatment for ADHD. The abuse potential for nonstimulants is not a major consideration. Non-stimulants are used when children do not respond well to stimulants or parents want an alternative option. Some of the nonstimulants are atomoxetine, viloxazine, guanfacine, and clonidine. When children are placed on these medications, it is important to monitor their blood pressure and heart rate (Newcorn et al, 2022).

In general, the major treatment goals for ADHD are to reduce and improve core symptoms. Close monitoring and collaboration with other medical and education providers is recommended to ensure patient-centered care.  Evaluation of educational needs for IEPs or 504 plans should occur on an annual basis. Recommendations for behavioral therapy and parent and child training classes to help improve core behaviors have been shown to be beneficial in long-term management. If medications are started, close monitoring of diet, weight, and vital signs are recommended (Magnus et al., 2023; Williams et al., 2023).

Intellectual and developmental disabilities (IDDs) fall under the NDD category as well. IDDs vary by age and gender. The occurrence is estimated at 10 to 15 children per 1,000 in the general population (Lee et al., 2023). Of those children, it is estimated that about 85% of them have only a mild intellectual disability (Lee et al., 2023).

The DSM-5-TR is used to diagnose intellectual disabilities. The IDD needs to occur before the age of 22 (some sources state the age of 18) and meet the criterion of A, B, and C for proper diagnosis of the intellectual disability (APA, 2022):

1. The presence of deficits in intellectual functions
2. The presence of deficits in adaptive functioning
3. Onset of the deficits in intellectual functions and adaptive functioning during the developmental period

To summarize and further define, the IDD occurs in the developmental period in which the individual experiences both intellectual and adaptive functioning deficits. Intellectual functions require (APA, 2022):

• Problem solving
• Abstract thinking
• Judgement
• Academic learning

Deficits in adaptive functioning, in which a failure exists for the individual to meet developmental and socio-cultural standards for independence, can impact (APA, 2022):

• Activities of daily life
• Communication
• Social interaction
• Participation at home and at school

Lee et al. (2023) explained that intellectual functioning is essentially “intelligence” and can be measured with the intelligence quotient (IQ). A score of 70 or below indicates intellectual deficits (Lee et al., 2023). Categorization of IDD falls under the severity level scores of (Lee et al., 2023):

• IQ of between 50-70: Mild intellectual disability
• IQ of between 35-50: Moderate intellectual disability
• IQ of between 20-35: Severe intellectual disability
• IQ of below 20: Profound intellectual disability

The evaluation is performed with the Stanford-Binet Intelligence Scales.

The DSM-5-TR is used to diagnose IDDs, but it is also helpful in informing a proper assessment of intellectual disabilities. IDDs can be caused by multiple factors and require an in-depth assessment to identify the problem.

The Adaptive Behavior Assessment System measures adaptive function. This scale measures the adaptive functioning of the individual with interactions socially, communication, and general living function (Lee et al., 2023).

The United States Department of Health and Human Services (HHS) (2021) explains that the means for securing an IDD diagnosis can be different for each child. For some conditions that are associated with IDDs, assessment might require blood tests for genetic conditions, an ultrasound during pregnancy, or even with amniocentesis during pregnancy (US Department of Health and Human Services, 2021). IDDs can also be diagnosed after birth and up to age 22. Therefore, later tests such as newborn screening after birth might capture other conditions that could eventually lead to IDDs (US Department of Health and Human Services, 2021).

Prenatal screening is recommended for identification of common IDD’s. Common screening tools to assess for IDDs are the Stanford-Binet Intelligence Scales and the Adaptive Behavior Assessment System (Lee et al., 2023).

Other screening tools that can be used include the following (David et al., 2022):

• The Vineland Adaptive Behavior Scale (VABS)
• The Health-Related Quality of Life Short Form Survey (SF-36)
• The Rapid Assessment for Developmental Disabilities, Second Edition (RADD-2)
• The WHO Disability Assessment Schedule (WHODAS 2.0)

Management of IDDs requires early recognition of the disability which includes evaluation to identify the overall disability and methods to improve overall daily functioning and reduction of worsening conditions that may impact the child’s future development (Lee et al., 2023). Behavioral interventions and educational support are necessary in the management.

A multidisciplinary collaborative approach needs to occur to coordinate academic modifications in the school environment and to treat any behavioral problems. Behavioral training can include cognitive behavioral therapy (CBT) that works with the individual to improve behaviors, emotions, social skills with organization and planning (Lee et al., 2023). It includes encouraging praise and reward in the behavioral training to help reduce potential behavioral misconduct (Lee et al., 2023).

Pharmacological treatment is selected based on the symptoms. If the child is demonstrating aggressive behavior, then risperidone may be considered. Risperidone (Risperdal ®) is a second-generation, or atypical, antipsychotic that is commonly used to treat aggressive behavior (McNeil et al., 2024). Aripiprazole (Abilify®) is another option that has been shown to work in managing these symptoms. Alsayouf et al. (2021) provides information that the Food and Drug Administration (FDA) has approved Risperidone and Aripiprazole for the treatment of aggression and irritability in children from the age of 5 years but further emphasizes that there are no approved medications to treat the core symptoms of ASD.

Nonpharmacological approaches to treating IDDs focus on providing support to improve the intellectual functioning and adaptation in school or their daily living activities. Vocational training can be offered to help the patient learn key skills like learning a specific skill that can be applied to the home or work setting (Lee et al., 2023). Family education is another approach that aids the patient and the family to learn about the condition.

David is a 6-year-old in the first grade. He lives with his father and 2 older brothers, aged 9 and 11. His mother passed away 4 years ago. He has been having difficulty in school over the past 8 months. He is hyperactive, often running around the classroom, unable to sit still in his chair, disruptive and impulsive with grabbing things from other classmates and interrupting his teacher, Ms. Jones.

In light of this, Ms. Jones contacted the school nurse, and the school nurse gave the teacher a Vanderbilt screening form to complete. Ms. Jones reached out to the father to talk about his behavior, lack of attention, and poor first semester grades in the class. Ms. Jones also wanted to talk to the father about the high score on the Vanderbilt form that she completed. Ms. Jones also indicated that he had trouble with letters like “D” and “B”. David’s father, Mr. Smith, indicates that his son is very hyperactive at home, and they have the same concerns. Mr. Smith indicates that it is also causing conflict among David’s other two male siblings because David constantly grabs their things and creates tension when he is disruptive at home or interacting with them. Mr. Smith informed the teacher that his own older brother suffered from hyperactivity as a child when they were growing up and had a learning disability, Dyslexia. Mr. Smith asks Ms. Jones what the next steps are. Ms. Jones indicated that David can be referred to a few different specialists but that she would recommend a child psychologist for further evaluation of his behavior and activity and decide on further treatment.

During the clinical evaluation, the child psychologist talked to Mr. Smith and asked about David’s interaction, attention, and behavior at home. The psychologist reviewed the Vanderbilt teacher form and the Vanderbilt parent form. Both scores were elevated and pointed to ADHD.

During the initial visit with the psychologist, David is very active in the room. He is touching all the equipment on the desk and moving from one thing to another. Mr. Smith voices his concerns to the psychologist that his lack of attention and hyperactivity is causing trouble in school and in relation to his interactions with his two older siblings. The psychologist tells Mr. Smith that he wants to talk to David and evaluate him in a multistep process. He then asks Mr. Smith to leave the office so he can meet with David to evaluate him alone.

The child psychologist starts to ask David questions about how he is doing. David tells the psychologist, “I am fine” and “I am bored.” David continues to roam around the room. The psychologist asks David to sit down and asks him to write his first name, draw a picture of a square and a circle. David writes his name, “bavib” and draws the square but then immediately gets up from his chair and goes to the window to grabs a plastic truck sitting on the windowsill. The psychologist asks him, “What do you think it is?” David responds loudly and aggressively, “You know it is a truck!” The psychologist asks him to come back and sit down to finish with the project. David says, “This is boring and I’m not doing it!” The psychologist asks, “What would you like to do? David replies, “Do you have any video games?”  He then runs to the toy box and starts pulling all the toys out of the box. The psychologist finishes the evaluation and calls the father back into the room.

The psychologist brings Mr. Smith back into the room, and he explains that David may have an NDD and that he will need additional testing. The psychologist diagnoses David with ADHD based on the teacher and the father’s reports of his activity and the Vanderbilt screening tool scores being elevated. The psychologist explains that the Vanderbilt teacher and parent screening scores were above the normal range. The psychologist recommends that Mr. Smith get David into some behavioral therapy with a therapist who specializes in pediatric ADHD and for Mr. Smith to also participate in some parental training in behavioral management.

They all discussed the next steps in the treatment plan, which include getting an individualized education program (IEP) set up so he could also be evaluated for his current learning disability and possible dyslexia. No medications are indicated currently until he sees the therapist. If medications are considered later, methylphenidate, more commonly known as Ritalin ®, will be trialed.

The CDC recommends that behavioral intervention be tried first in children between the ages of 4-7 (CDC, 2024b). A follow-up appointment was scheduled for one month later to recheck David’s behavior after one month of therapy. Information was also provided for Mr. Smith to contact the office if there are any additional questions or any worsening of the condition.

In one month, David sees the psychologist for the follow-up appointment. Mr. Smith tells the psychologist that therapy has not really helped. David has been going to therapy 2x per week for the past month. He is still having the same issues in school, and it has worsened, and he does not want to go to therapy and is getting more frustrated and disruptive at home. Mr. Smith is requesting a trial of Ritalin ® and would like to come back in one month for a follow-up. The psychologist explains that he will need to refer them to a psychiatrist or a psychiatric mental health nurse practitioner (PMHNP) to prescribe the medication. Recommendations were given to the father to continue with therapy until they get an appointment with the other provider for medication initiation and to follow-up again in one month for re-evaluation after starting the medication. Mr. Smith agrees to the plan of care recommendations.