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| EDITORIAL |
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| Year : 2020 | Volume
: 9
| Issue : 2 | Page : 53-54 |
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Neurobehavioral disorders: Trends and solutions
Asok Kumar Datta
Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal, India
| Date of Submission | 01-Jun-2020 |
| Date of Decision | 20-Jun-2020 |
| Date of Acceptance | 25-Jun-2020 |
| Date of Web Publication | 27-Apr-2021 |
Correspondence Address:
Dr. Asok Kumar Datta
Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WKMP-0206.314816
How to cite this article:
Datta AK. Neurobehavioral disorders: Trends and solutions. J Pediatr Assoc India 2020;9:53-4 |
Among the common neurobehavioral disorders among children, we are well acquainted with two major problems – Attention Deficit Hyperactive Disorder (ADHD) and Autism Spectrum Disorder (ASD). They are actually the two different grades of developmental manifestation of the same spectrum. Normal development is known to follow a specific trajectory. There are neuromotor, neurocognition, and neurobehavior components of development. Neuromotor development can be divided as gross motor, fine motor, and oro-motor types. On the other hand, neurocognition domain comprises language and nonverbal/visuomotor coordination. While language development is associated more with the social interaction, visual-motor coordination is associated with the adaptive part of the development process. Neurobehavioral part of development is comprised attention, activity, and impulsivity.
Of the three major parts of the “Neurobehavioral” component of developmental trajectory, the area which at times gets lagged behind is described as the “Dissociated area.” Such dissociation when exceeds beyond 15% of normal range is considered as “Significant.”
At times, the development process may not measure up to be at par with normal expectation. It can proceed in a way atypical of the usual process. This can be explained by taking the example of how a 2-year-old child may develop way beyond his age in a domain with level expected normally at 4 years of age but may lag behind in other areas of development appropriate for age. Such phenomenon is known as “Developmental deviation.” ADHD is the classical example of developmental dissociation, whereas ASD is an example of developmental deviation.
Incidences of developmental “Dissociation” and “Deviations” are found to be on the rise these days. Researching the possible reasons behind such phenomena in the community brought to light various factors which had not meet the clinicians' eyes before. Among the factors involved, impact of various gadgets, increasing number of nuclear families with parents having no time to interact with their kids top the list. The other common contributing factors being overuse of drugs, interventions affecting in antenatal, intranatal, and postnatal periods. Hence, these factors are grouped under the category of “Development Disturbances.”
Environmental factors too are can play a role in the presence of existing genetic predisposition, resulting in expression of disease states of those kids. In neurobehavioral disorders such as ADHD or Autism, both “Developmental” and “Environmental” factors may be simultaneously operating. In ADHD, release of neurotransmitters such as dopamine and noradrenaline are deficient. As a result, the child suffers from inattention, hyperactivity, and impulsive behavior. The pharmacological basis of treatment of this disorder is based on this and found to yield impressive prognosis.
In ASD, various factors are at play, starting from the intrauterine life itself. There is also the presence of improper connections involving different neurons in ASD, resulting in alterations in neurotransmitters such as serotonin and acetylcholine. Various syndromes too such as Down Syndrome, Fragile X syndrome, and some metabolic disorders predispose to ASD.
Among the management principles presently employed, “Neuronal Plasticity” is considered to be highly contributive toward improvement in this specific category of neurobehavioral problems. It is found that, in preschool children with ADHD, behavioral modification therapy can improve the condition significantly. Although previously it was thought that ADHD was uncommon in the preschool age, this was found to be a misconception; proved with rising incidence of ADHD cases in that particular age group. Daily positive reinforcement therapy, along with stimulant therapy sometimes, can be often used to combat the disease in these age groups.
In ASD, the onset of problems might start appearing at early age. There is failure of meaningful and purposeful interaction from the very beginning in a substantial proportion of cases. Interaction between parents and children for at least 40 h a week has shown visible improvement.
In both of these two conditions, associated comorbidities such as language delay, learning disorder, seizures and gastrointestinal disorders can manifest. As both of these disorders are rising and as because we are not alert enough to diagnose these problems early, fruitful intervention is not optimum in our country, looking at the trained caregivers and patient load or demand. It is high time to awaken all stakeholders and spread the message to our fellow pediatricians on these issues and empower them with the knowledge for early recognition and productive intervention.
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