If you missed today’s workshop by Anthony L. Rostain, M.D., entitled: “Improving Clinical Outcomes for Children and Adolescents with Neurodevelopmental Disorders,” you missed an outstanding presentation. First, an admission – when I saw the title and Dr. Rostain’s credentials before the workshop, I immediately thought “Three hours of brain pictures and pharmacology, Oh no!”  Boy was I ever wrong! Yes, there were some brain pictures and pharmacology, but just the right amount. Dr. Rostain’s humor and expertise enhanced this dynamic and information packed workshop, and the 3 hours went by quickly.

All learning objectives were met for this workshop.

• Describe common neurodevelopmental disorders in children and adolescents
• State the challenges in assessing and treating childhood neurodevelopmental disorders
• Discuss effective interventions for children and adolescents with neurodevelopmental disorders

In discussing neurodevelopmental disorders, Dr. Rostain focused on:

• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Autistic Spectrum Disorder, Social Pragmatic Disorder, Nonverbal Learning Disorder
• Specific Learning and Communication Disorders
• Tic Disorders and Tourette Syndrome

At the start of the workshop, Dr. Rostain presented an overview of Neurodevelopmental Disorders (NDD). He said that these typically have the following characteristics:

• Manifest early in development
• Highly variable presentation
• Range from specific to global impact
• Deficits cause impairment
• Multiple domains of functioning
• Often overlapping conditions
• Highly co-morbid

These disorders can be genetic and can influence the life course of an individual. As an alternative to the medical model of NDD, Dr. Rostain presented Neuro-diversity which include: “Difficulties with organization, memory, concentration, time, sequencing and poor listening skills. All may lead to low self-esteem, anxiety, and depression if others are not aware.”

These individuals can be particularly vulnerable to impairment in many areas including:

• Developmental
• Genetic
• Psychosocial
• Medical
• Environmental
• Treatment

Dr. Rostain gave a brief overview of the neurobiology of ADHD. He discussed the role of the prefrontal cortex and optimal levels of catecholamines in regulation of attention, emotions, and the importance of self-regulation. During his discussion Dr. Rostain specified the importance of executive functioning in maintaining emotional regulation which he defined as:

“The internal and external processes involved in: initiating, avoiding, inhibiting, maintaining, and modulating the occurrence, form, intensity, or duration of internal feeling states, emotional-related physiological’ attentional processes, motivational states and/or the behavioral concomitants of emotion in the service of accomplishing affect-related biological or social adaptations or achieving individual goals.”

He pointed out that ADHD has a significant role in self-regulation. Dr. Rostain said that ADHD may impact dopamine pathways in the brain leading to a Reward Deficiency Syndrome (RDS). This can lead to increased risk for addictive behaviors, high risk behaviors, and increased aggression.

The presentation also included a brief discussion of other NDD disorders including Autism Spectrum Disorder (ASD), Non-Verbal Learning Disability, Semantic-Pragmatic Disorder, and Tourette  Disorder. He pointed out that there are many similarities within ASD symptoms but ASD appears to be a combination of many genetic and environmental influences best described as a profile of multiple behaviors and skill deficits.

Both Non-verbal Learning Disability and Semantic-Pragmatic Disorder were briefly discussed. It was nice to hear the discussion. It’s been many years since these disorders have been prominent. Both can be difficult to detect and frequently debilitating. Often, these children are seen simply as quirky and annoying because they talk a lot, but lack comprehension of the world around them.  When left untreated, these disorders can lead to serious and often lifelong functional and emotional impairments.

There are many assessment challenges with NDD. According to Dr. Rostain, there is a tendency to compartmentalize treatment based on symptoms. With NDD, there is much co-morbidity, and symptoms often overlap with other disorders. Standardized assessments often require that impairment fall two standard deviations below the mean. The experience of distress or impairment may not meet this threshold but the individual may still require treatment. Dr. Rostain also reminded the audience that behavior is multidimensional. The emotional state, and attention of the person being assessed, is crucial to an adequate diagnosis. Dr. Rostain stressed that clinical judgment is essential when assessing individuals with NDD.

NDD Assessment Principles include the following according to Dr. Rostain:

• Thorough and comprehensive-not mere symptom counts
• Include as many collateral informants as possible
• Obtain medical records, past evaluations, i.e., “thick descriptions”
• Use scales and tests categorically and dimensionally
• Establish onset, chronicity, severity, and pervasiveness of impairment

During his presentation Dr. Rostain provided the names of several assessment instruments for assessment of Executive Functions and emotional dysregulation.

Dr. Rostain emphasized that an assessment for NDD should be comprehensive for the best treatment outcome. Regardless of the assessment methods, clinical judgement is a requirement. Dr. Rostain also talked about the importance of integrative treatment as the “Gold Standard” with these disorders. For example, he said that the emotional problems don’t always go away with treatment for ADHD. He emphasized that psychoeducation is essential to help the child and family become ready to accept treatment.

While treatment for NDD was presented throughout his presentation, near the end of the workshop, Dr. Rostain listed several evidenced based psychosocial interventions including:

• Parent/Family Focused Treatments, especially Parent Behavior Training
• Classroom Behavioral Interventions
• Classroom Academic Interventions
• Child-Focused Cognitive Interventions
• Social Skills Interventions

Dr. Rostain again stated that integrative treatment works best He emphasized that the child with NDD is best served when the family, the school and medical/behavioral health services work together.

Today’s presentation by Dr. Rostain was refreshing. He showed respect for the audience in that he assumed participant competence by not simply providing a “cookbook” with step-by-step treatment techniques. His presentation focused on understanding concepts of Neurodevelopmental Disorders and impact on the lives of adolescents and their families. He emphasized the importance of including families and the importance of parent training in treatment for NDD. His takeaway messages were “Neurodiversity is Fabulous” and “Different does not equal Pathology.” In short, embrace neuro-complexity and focus treatment on impairment and experience of the individual not just the symptoms.

I found this to be a very satisfying workshop. Any thoughts?