Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges.

People with ASD may behave, communicate, interact, and learn in ways that are different from most other people. There is often nothing about how they look that sets them apart from other people.  The abilities of people with ASD can vary significantly. For example, some people with ASD may have advanced conversation skills whereas others may be nonverbal. Some people with ASD need a lot of help in their daily lives; others can work and live with little to no support.

ASD begins before the age of 3 years and can last throughout a person’s life, although symptoms may improve over time. Some children show ASD symptoms within the first 12 months of life. In others, symptoms may not show up until 24 months of age or later. Some children with ASD gain new skills and meet developmental milestones until around 18 to 24 months of age, and then they stop gaining new skills or lose the skills they once had.

As children with ASD become adolescents and young adults, they may have difficulties developing and maintaining friendships, communicating with peers and adults, or understanding what behaviors are expected in school or on the job. They may come to the attention of healthcare providers because they also have conditions such as anxiety, depression, or attention-deficit/hyperactivity disorder, which occur more often in people with ASD than in people without ASD.

Risk Factors

There is not just one cause of ASD. There are many different factors that have been identified that may make a child more likely to have ASD, including environmental, biologic, and genetic factors.

Although we know little about specific causes, the available evidence suggests that the following may put children at greater risk for developing ASD:

• Having a sibling with ASD
• Having certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis
• Experiencing complications at birth
• Being born to older parents

Attention Deficient Hyperactivity Disorder (ADHD) : It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

• Combined Presentation: Symptoms of the above two types are equally present in the person.

Risk factors

Risk factors for ADHD may include:

• Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder

• Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings

• Maternal drug use, alcohol use or smoking during pregnancy
• Premature birth

Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but that's not the same as ADHD.

Complications

ADHD can make life difficult for children. Children with ADHD:

• Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
• Tend to have more accidents and injuries of all kinds than do children who don't have ADHD
• Tend to have poor self-esteem
• Are more likely to have trouble interacting with and being accepted by peers and adults
• Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions

ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

• Oppositional defiant disorder (ODD),generally defined as a pattern of negative, defiant and hostile behavior toward authority figures
• Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals
• Disruptive mood dysregulation disorder,characterized by irritability and problems tolerating frustration
• Learning disabilities, including problems with reading, writing, understanding and communicating
• Substance use disorders, including drugs, alcohol and smoking
• Anxiety disorders, which may cause overwhelming worry and nervousness, and include obsessive compulsive disorder (OCD)
• Mood disorders, including depression and bipolar disorder, which includes depression as well as manic behavior
• Autism spectrum disorder, a condition related to brain development that impacts how a person perceives and socializes with others
• Tic disorder or Tourette syndrome, disorders that involve repetitive movements or unwanted sounds (tics) that can't be easily controlled.

Behavioral Issues in Children

Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child’s age at the time, persist over time, or are severe.  Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are sometimes called externalizing disorders.

The most common disruptive behaviour disorders include oppositional defiant disorder (ODD), conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). These three behavioural disorders share some common symptoms, so diagnosis can be difficult and time consuming. A child or adolescent may have two disorders at the same time. Other exacerbating factors can include emotional problems, mood disorders, family difficulties and substance abuse. 

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles.

All people with CP have problems with movement and posture. Many also have related conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures).

Types of Cerebral Palsy

• Stiff muscles (spasticity)
• Uncontrollable movements (dyskinesia)
• Poor balance and coordination (ataxia)
• Mixed cerebral palsy

Causes and Risk Factors

CP is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The abnormal development of the brain or damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child’s life, while the brain is still developing. CP related to abnormal development of the brain or damage that occurred before or during birth is called congenital CP. The majority of CP (85%–90%) is congenital. In many cases, the specific cause is not known. A small percentage of CP is caused by abnormal development of the brain or damage that occurs more than 28 days after birth. This is called acquired CP, and usually is associated with an infection (such as meningitis) or head injury.

Conduct Disorder

Conduct Disorder : Conduct disorder is a type of behavior disorder. It’s when a child has antisocial behavior. He or she may disregard basic social standards and rules. He or she may also:

• Be irresponsible
• Skip school or run away (delinquent behavior)
• Steal or do other things to violate the rights of others
• Physically harm animals or other people, such as committing assault or rape

These behaviors sometimes happen together. But one or more may occur without the others.

RISK FACTOR

A conduct disorder is more common in boys than in girls. It is also more likely to develop in children or teens who come from homes that are:

• Disadvantaged
• Dysfunctional
• Disorganized

Children with these mental health problems are also more likely to have conduct disorder:

• Mood or anxiety disorders
• Posttraumatic stress disorder (PTSD)
• Substance abuse
• Attention-deficit/hyperactivity disorder (ADHD)
• Learning problems

Children or teens who are considered to have a difficult temperament are more likely to develop behavior problems.

Developmental Coordination Disorder (DCD) Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination. It causes a child to perform less well than expected in daily activities for their age, and appear to move clumsily.

DCD is thought to be around 3 or 4 times more common in boys than girls, and the condition sometimes runs in families.

Causes of DCD

Doing co-ordinated movements is a complex process that involves many different nerves and parts of the brain.

Any problem in this process could potentially lead to difficulties with movement and co-ordination.

It's not usually clear why co-ordination doesn't develop as well as other abilities in children with DCD.

However, a number of risk factors that can increase a child's likelihood of developing DCD have been identified.

These include:

• being born prematurely, before the 37th week of pregnancy
• being born with a low birth weight
• having a family history of DCD, although it is not clear exactly which genes may be involved in the condition

the mother drinking alcohol or taking illegal drugs while pregnant.

Intellectual Disability: Intellectual disability1 involves problems with general mental abilities that affect functioning in two areas:

• Intellectual functioning (such as learning, problem solving, judgement).
• Adaptive functioning (activities of daily life such as communication and independent living).

Additionally, the intellectual and adaptive deficit begin early in the developmental period.

Intellectual disability affects about 1% of the population, and of those about 85% have mild intellectual disability. Males are more likely than females to be diagnosed with intellectual disability.

Learning Disability -

Dyslexia A specific learning disability that affects reading and related language-based processing skills.

Dysgraphia A specific learning disability that affects a person’s handwriting ability and fine motor skills.

Dyscalculia A specific learning disability that affects a person’s ability to understand numbers and learn math facts.

Non-Verbal Learning Disabilities

Has trouble interpreting nonverbal cues like facial expressions or body language and may have poor coordination.

Oral / Written Language Disorder and Specific Reading Comprehension Deficit

Learning disabilities that affect an individual’s understanding of what they read or of spoken language. The ability to express one’s self with oral language may also be impacted.

Even the best-behaved children can be difficult and challenging at times. But if your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).

ODD can vary in severity:

• Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
• Moderate. Some symptoms occur in at least two settings.
• Severe. Some symptoms occur in three or more settings.

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly emotionally reactive to situations or having trouble tolerating frustration

Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision

Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance use disorder

Environment — oppositional and defiant behaviors can be strengthened and reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers

Complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children with ODD may struggle to make and keep friends and relationships.

ODD may lead to problems such as:

• Poor school and work performance
• Antisocial behavior
• Impulse control problems
• Substance use disorder
• Suicide

Many children and teens with ODD also have other mental health disorders, such as:

• Attention-deficit/hyperactivity disorder (ADHD)
• Conduct disorder
• Depression
• Anxiety
• Learning and communication disorders

Treating these other mental health disorders may help improve ODD symptoms. And it may be difficult to treat ODD if these other disorders are not evaluated and treated appropriately.

Poor school performance not only results in the child having a low self-esteem, but also causes significant stress to the parents. There are many reasons for children to under perform at school, such as, medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder, emotional problems, poor socio-cultural home environment, psychiatric disorders and even environmental causes.

The information provided by the parents, classroom teacher and school counselor about the child's academic difficulties guides the pediatrician to form an initial diagnosis. However, a multidisciplinary evaluation by an ophthalmologist, otolaryngologist, counselor, clinical psychologist, special educator, and child psychiatrist is usually necessary before making the final diagnosis. It is important to find the reason(s) for a child's poor school performance and come up with a treatment plan early so that the child can perform up to full potential.

Sleep Disorders in Children Children and adolescents need at least 9 hours of sleep every night. Sleep problems and a lack of sleep can have negative effects on children's performance in school, during extracurricular activities, and in social relationships.

A lack of sleep may cause:

• Accidents and injuries
• Behavior problems
• Impulsive behavior
• Mood problems
• Memory, concentration, and learning problems
• Performance problems
• Slower reaction times
• Overeating

Talk to your pediatrician if your child shows any of the following signs of a sleep problem:

• Snoring
• Breathing pauses during sleep
• Trouble falling asleep
• Problems with sleeping through the night
• Trouble staying awake during the day
• Unexplained decrease in daytime performance
• Unusual events during sleep such as sleepwalking or nightmares 
• Teeth grinding
• Bedwetting
• Restless sleep
• Trouble waking up in the morning

Up to 50% of children will experience a sleep problem. Early identification of sleep problems may prevent negative consequences, such as daytime sleepiness, irritability, behavioral problems, learning difficulties, motor vehicle crashes in teenagers, and poor academic performance. Obstructive sleep apnea occurs in 1% to 5% of children. Polysomnography is needed to diagnose the condition because it may not be detected through history and physical examination alone. Adenotonsillectomy is the primary treatment for most children with obstructive sleep apnea. Parasomnias are common in childhood; sleepwalking, sleep talking, confusional arousals, and sleep terrors tend to occur in the first half of the night, whereas nightmares are more common in the second half of the night. Only 4% of parasomnias will persist past adolescence; thus, the best management is parental reassurance and proper safety measures. Behavioral insomnia of childhood is common and is characterized by a learned inability to fall and/or stay asleep. Management begins with consistent implementation of good sleep hygiene practices, and, in some cases, use of extinction techniques may be appropriate. Delayed sleep phase disorder is most common in adolescence, presenting as difficulty falling asleep and awakening at socially acceptable times. Treatment involves good sleep hygiene and a consistent sleep-wake schedule, with nighttime melatonin and/or morning bright light therapy as needed. Diagnosing restless legs syndrome in children can be difficult; management focuses on trigger avoidance and treatment of iron deficiency, if present.

Social communication disorder (SCD) is characterized by persistent difficulties with the use of verbal and nonverbal language for social purposes. Primary difficulties may be in social interaction, social understanding, pragmatics, language processing, or any combination of the above. Social communication behaviors such as eye contact, facial expressions, and body language are influenced by sociocultural and individual factors. There is a wide range of acceptable norms within and across individuals, families, and cultures. Specific communication challenges may become apparent when difficulties arise in the following:

• communicating for social purposes in ways that are appropriate for the particular social context
• changing communication to match the context or needs of the listener
• following rules for conversation and storytelling
• understanding nonliteral or ambiguous language
• understanding that which is not explicitly stated
• sentence grammar and lexical semantics
• inferential language
• discourse comprehension
• misinterpretation of contextual meaning