prevalence of autism spectrum disorder is 1% of the population (APA, 2013); race and ethnic group differences in diagnostic Etiology and neurobiology of autism spectrum disorder The cause of autism spectrum disorder is poorly understood. There is a strong genetic contribution to autism spectrum disorder, but the specific genes involved have not been identified. It is likely that many different genes play a role, along with environmental factors that have not yet been well- delineated (Lord et al., 2018). Brain regions implicated in autism spectrum disorder are the brainstem, cerebellum, hippocampus, amygdala, and cortex.
rates are complex and may have diminished in recent years (Becerra et al., 2014; Christensen et al., 2019).
Studies suggest abnormal brain development, with some regions larger in affected than unaffected children and some regions with lower numbers of particular types of neurons or with some groups of neurons displaced. It is hard to draw conclusions from these data, but there is clear evidence that the brain is developing in ways that differ from children who do not have autism spectrum disorder, and that this maldevelopment may occur during prenatal development (Ecker et al., 2017). a neuropsychological evaluation can be useful to determine intellectual functions. Further, it is useful to learn about a child’s cognitive and emotional strengths and weaknesses for treatment planning.
Utility of neuropsychological evaluations for autism spectrum disorder A neuropsychological evaluation might be requested as part of a diagnostic evaluation for autism spectrum disorder or to assist in treatment planning. As stated earlier, intellectual impairment may accompany autism spectrum disorder and
PSYCHIATRIC COMORBIDITIES
Clinically significant levels of depressive symptoms, anxiety, aggression, irritability, or anger can significantly exacerbate functional impairment and impact prognosis for the disorders described above. Psychiatric symptoms are assessed with behavior rating scales that are completed by parents, teachers, and other significant caregivers. The neuropsychologist also observes patients for signs of psychopathology and, for older children, self-reports of internalizing (e.g., depressive) and Chapter summary This chapter introduced a few disorders of childhood that are often seen in neuropsychological practice. The most common reasons for referral are to assist with diagnosis and treatment planning. Neuropsychological evaluations also are useful for establishing a baseline against which future development or developmental disorders that usually persist into adulthood, to some degree. Thus, it is not uncommon for a neuropsychologist to evaluate an adult for ADHD, autism spectrum disorder, or specific learning disorder. This chapter will cover disorders that involve acquired rather than developmental disorders. The list of potential disorders that could be covered is long and, thus, this review is necessarily selective. Neurocognitive disorder due to traumatic brain injury (TBI), neurocognitive disorder due to multiple sclerosis (MS), and neurocognitive disorder due to Alzheimer’s disease will be covered because these are some of the most prevalent disorders that neuropsychologists encounter in midlife and older adults. Two types of brain injuries Traumatic brain injuries (TBIs) are the most common cause of death and disability in young adults (Capizzi et al., 2020), and Black people sustain proportionately more concussions that White people (Brenner et al., 2020). They also are common in older adults and very young children (Centers for Disease Control and Prevention, 2016). TBIs are classified into two broad types. Open head injuries are rare and more deadly; they occur when the skull is crushed or penetrated by an object (e.g., a bullet). Closed head injuries are more common and occur when the skull remains intact. A closed head injury might occur in a motor vehicle accident, when the head is quickly jerked, rotated, Neuropathology of traumatic brain injury “Primary injuries” refer to the brain damage caused by forces impacting the brain at the time of the trauma. For example, a primary injury could be the brain tissue damaged by a bullet or the region of the brain that was bruised during a closed head
externalizing (e.g., aggressive) symptoms are obtained. If psychiatric comorbidities are present, treatment is recommended to maximize functioning. Treatment might involve parent training and education, implementation of behavioral management strategies, individual psychotherapy, skills training groups, or psychiatric consultation to evaluate the possibility of medication management.
decline can be measured. Neuropsychological evaluations produce a wealth of data to assist children, families, and other mental health professionals to learn about a child’s strengths and weaknesses, understand what to expect in the future, and understand how to maximize the child’s functioning. CHAPTER 5: NEUROCOGNITIVE DISORDERS IN ADULT AND GERIATRIC NEUROPSYCHOLOGY Introduction The disorders reviewed in the previous chapter are
A major neurocognitive disorder is diagnosed when there is “evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains,” “the cognitive deficits interfere with independence in everyday activities,” and the deficits are not due to delirium or another mental disorder (APA, 2013, pp. 602-603). A mild neurocognitive disorder is indicated when there is evidence of cognitive decline but the “cognitive deficits do not interfere with capacity for independence in everyday activities”; however, there may or may not be inefficiencies in performances of activities of daily living (APA, 2013, p. 605). Major and mild neurocognitive disorders may occur with or without behavioral disturbance and can be noted as mild, moderate, or severe.
NEUROCOGNITIVE DISORDER DUE TO TRAUMATIC BRAIN INJURY
or hit at the time of impact. A closed head injury also might occur when someone slips and falls. DSM-5 diagnostic criteria for neurocognitive disorder due to TBI are met when there is evidence of TBI, such as impact to the head, and one or more of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, or neurological signs (e.g., imaging reveals injury, new seizure activity) (APA, 2013). The disorder presents immediately following the TBI and persists after an acute recovery period.
injury. Often, in closed head injury there is bruising at the site of impact, called the coup injury, and at a site directly opposite the injury, called the contrecoup injury, which occurs when the brain rebounds or bounces off the opposite side of the skull after
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