What is a Neurodevelopmental Disorder?

Jul 29

Neurodevelopmental disorders are problems with childhood brain development. They can include both physical, cognitive, and emotional abnormalities.

These disorders can range from mild to severe, and can profoundly impact all aspects of a child’s life.

Some neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), sensory processing disorder (SPD), Tourette’s syndrome, and autism, to name a few. As similar brain circuits are involved in all of these, they tend to overlap, and many children present with more than one neurodevelopmental disorder.

How Common are Neurodevelopmental Disorders?

Researchers from the Centers for Disease Control and Prevention report that roughly 1 in 6 children, or 13.87% struggle with some form of neurodevelopmental disorder. Over the last 12 years, the prevalence of neurodevelopmental disorders in children has increased by 17%, with 1.8 million more children struggling with neurodevelopmental problems. The prevalence of ADHD has increased by 33%, whereas the prevalence of autism has increased by a staggering 289.5%.

Boys are twice as likely as girls to live with a neurodevelopmental disorder. These disorders are present in all ethnic populations, but are slightly more common among indigenous populations.

Rates of neurodevelopmental disorders appear to be rising, for reasons that have yet to become clear (1).

What Causes Neurodevelopmental Disorders?

The cause of these disorders remains an open and controversial question. There are definite genetic components to these conditions, and a family history is a primary risk factor. It appears that neurodevelopmental disorders exist on a genetic continuum, with some shared genetic features with psychiatric disorders (2).

Additional factors that may increase the chances of these disorders include low birth weight, fetal alcohol syndrome, tobacco smoke exposure, and exposure to lead (3).

Many researchers are linking increasing rates of neurodevelopmental disorders to environmental toxins (4), the rise of information technology (5), changes in physical activity (6), and even the way that social media algorithms impact brain development (7). These issues are far from settled. While genetics do seem to be the primary driver for neurodevelopmental disorders it seems plausible that these other factors, while not causal, may be contributing to the increase of these disorders seen in the population.

There is a great deal of controversy involved in popular culture regarding what causes neurodevelopmental disorders. For the record, vaccines do not cause autism. That fallacy needs to be put to rest (8,9). However, there is a good deal of literature that implies that autistic children have difficulty with gut function and liver detoxification (10,11). This may make them more susceptible to environmental toxins, gut dysbiosis, and a host of other metabolic and environmental issues that make it difficult for them to adapt to their environment (12).

Many of these disorders are secondary to birth complications (13), or traumatic brain injuries (14). While there are genetics that lurk behind the conditions, genes only load the gun, and it usually takes some form of environmental insult to pull the trigger. This may be something like a concussion when learning to walk, a period of hypoxia from a traumatic birth, or an early infection.

What are the Symptoms of Neurodevelopmental Disorders?

The symptoms that present depend on the specific disorder the individual is struggling with.

However, one way or another all of these impact behavior, self-control, emotional regulation, memory, and the ability to learn. Problems with motor coordination are also very common, in terms of both gross and fine motor skills. These children often have poor posture and floppy tone, and may struggle with learning to crawl, walk, or ride a bike.

How do Neurodevelopmental Disorders Affect the Brain?

Neurodevelopmental disorders are best viewed as problems involving the function and integration of several important brain regions and pathways. These include:

The frontal and prefrontal cortex: These regions are involved in cognition, reasoning, planning, and other tasks considered to be executive functions. This is where most high-level cognitive processing takes place. Dysfunction in these regions leads to inattention, poor organization, and loss of impulse control (15).

The limbic system: This series of structures are found deep within the brain. They regulate emotional responses. Problems in these structures result in frequent emotional outbursts, poor stress modulation, meltdowns, agitation, and inattention (16).

The basal ganglia: These circuits receive input from throughout the brain, and are responsible for regulating communication between different brain regions and circuits. They function essentially as the gas pedal and brake pedal for the brain. Every thought, emotion, sensory input, movement, and behavior is turned on and turned back off by the basal ganglia. Problems with these systems result in poor impulse control, obsessive and compulsive thoughts and behaviors, poor emotional control, and poor attention and focus (17).

The brainstem: Many critical neurological processes take place in the brainstem. The reticular activating system is the brain’s primary arousal system. It lives at the top part of the brain stem, and sends neurotransmitters up into the frontal lobe to activate a host of brain regions. Problems here can create inattention, fatigue, poor concentration, and sleep problems (18).

The cerebellum: This system is involved in motor control and coordination. It is responsible for the regulation of balance, gait, and both gross and fine motor control. It has also been shown to be involved in a wide range of cognitive processes. Dysfunction in the cerebellum has been implicated in virtually every neurodevelopmental condition, and appears to be of major significance in autistic spectrum disorders (19).

There are myriad ways that the brain can be affected during neurological development.

Throughout most of pregnancy the brain is adding roughly 250,000 nerve cells per minute. There are a number of essential stages of brain development that must take place during pregnancy and beyond in order for the brain to develop normally:

1. proliferation of a vast number of undifferentiated brain cells;

2. migration of the cells toward a predetermined location in the brain and the beginning of their differentiation into the specific type of cell appropriate to that location;

3. aggregation of similar types of cells into distinct regions;

4. formation of innumerable connections among neurons, both within and across regions;

5. competition among these connections, which results in the selective elimination of many and the stabilization of the 100 trillion or so that remain.

This last stage involves a process called synaptic pruning, whereby the brain gets rid of unnecessary connections and reinforces the ones that are most important (38).

When you are born, much of the brain is an undifferentiated soup of neurons, and we need environmental input to cause these to connect and develop appropriate pathways. We get much of this input from our sensory system by way of motor reflexes. Simply put, your brain needs input from muscles and joints to stimulate the spinal cord, brainstem, cerebellum, and brain to properly develop.

The brain develops based on movement, but when you are born, you don’t know how to move.

Because of this, babies are born with a series of primitive reflexes, such that when a body part is stimulated by touch or pressure, it causes a reflex movement. This is why babies are always flapping and squirming, and why you can stroke a cheek and the baby start to suckle, and so on.

People are always talking about reptilian brain, but there are primitive reflexes involving the inner ear that are best thought of as fish brain, reflecting earlier stages in evolution.

Primitive reflexes are like evolutionary hangovers baked into the spinal cord and brainstem.

When an infant receives sensory input, primitive reflexes trigger a motor response, which sends input from muscles and joints up into the cord, brainstem, and brain. This input stimulates neurons in the brain, which causes them to stabilize and wire together in pathways.

When these central pathways are properly stabilized, they fire back down the spinal cord and ultimately shut off the primitive reflex.

There are a few dozen primitive reflexes that have been identified, such as the Babinski reflex. If you scrape the bottom of an infant’s foot, toes will normally fan up. But by the time the child is 10 months old, the same input should make the toes curl. This is because the input from the bottom of the foot stimulates the brain, promotes neuronal stability and plasticity, and ultimately it causes it to fire down and shut off the motor response. Most primitive reflexes should be long gone by the child’s first birthday.

Many children lack the appropriate stimulation for one reason or another at the critical stages in early motor development, and as such they continue to show retained primitive reflexes into adolescence or even early adulthood.

If we lose the ability to shut off primitive reflexes later in life, these primitive reflexes are known as frontal release signs, or pathological reflexes, and imply a brain injury or other central process.

Primitive reflexes are critically important, because the areas of the brain that they stimulate are not just about doing things like making toes curl. The brain regions involved function as communication nodes, and are primary areas that allow the brain to properly wire together and communicate.

When these brain areas come online, they facilitate efficient communication between various parts of the brain. When they do not connect properly, brain function can be very inefficient. Retained primitive reflexes have been shown to exist in a wide variety of neurodevelopmental disorders (20-22).

Fortunately, it is not difficult to attenuate a primitive reflex, it simply involves identifying which reflexes are retained and then putting in reps with some simple exercises that will resolve the reflex. When this occurs, we often see dramatic changes in brain function, and neurological development seems to accelerate at breakneck speed (23).

Failed primitive reflex integration can be seen as a bottom-up process of brain development. As the child becomes older, top-down processing becomes equally important. There is an area of the brainstem called the midbrain, which is the primary relay for light and sound coming into the brain. It is involved in a number of motor pathways, and also drives stress responses. There are areas that produce neurotransmitters that stimulate the frontal lobe and the limbic system or emotional brain, and areas that act as the brain’s primary arousal center. Keeping the midbrain under control is a critical aspect of behavioral modulation.

When higher brain structures such as the prefrontal cortex and basal ganglia develop, these systems fire back down to help shut off the midbrain. There are pathways in these systems that are involved in executive function such as planning, task completion, working memory, and big-picture thinking. There are pathways that are specifically about emotional regulation. And there are important pathways involved in what is called response-inhibition.

These modulation systems develop slower, and are honestly not done baking until you are around age 25. Response inhibition pathways come from higher brain centers such as the dorsolateral prefrontal cortex, and ventral frontostriatal pathways. When their development lags, the child essentially becomes a slave to the environment. Response inhibition is the ability to shut off unwanted secondary stimuli, such as the feeling of fabric on your skin, the sound of the air conditioner, or even visual movement. When these systems are impaired, the child will be unable to inhibit sensory input, and their life can be reduced to a series of “hey, shiny thing” moments.

The systems involved in response inhibition also function in emotional modulation and behavioral regulation. When they are impaired, a host of behavioral and emotional symptoms can present.

Many of the brain regions involved in response inhibition also function in the production of specific eye movements. Eye movements are very commonly impaired in neurodevelopmental disorders (24). The frontal lobe, the seat of personality and cognition, is also involved in the production of eye movements called saccades. Saccades are fast eye movements as you jump from target to target. They are critical for attention, and children with deficits in saccades often show attentional issues (25). Rehabilitation of these regularly shows significant improvement in attention.

Smooth pursuit eye movements, or the ability to accurately follow a moving target, are in large part a function of the brain’s parietal lobes. These brain regions are also where primary sensory input goes, such as touch and pressure. This is where the primary physical map of the body exists in the brain. Deficits in smooth pursuit are regularly seen in sensory processing disorders and similar conditions. Rehabilitation of these eye movements can be very helpful to improve these disorders (26).

The dorsolateral prefrontal cortex is an area critically involved in response inhibition. It is also responsible for eye movements known as anti-saccades. These involve the presentation of a target, and require that the individual suppress the visual reflex to move the eyes toward the target, and instead move them in the opposite direction. This involves a cognitive choice and higher levels of executive function. When the circuits involved in anti-saccade production are not efficient, response inhibition fails, and with it goes emotional and behavioral regulation. We find that anti-saccade production is impaired in virtually all cases of behavioral modulation disorders. We also find that when we rehabilitate these eye movements, we regularly see great improvement in attentional, emotional and behavioral regulation (27).

There are a host of other types of therapies we employ in these cases. All of our protocols are data-driven, based on the most current neuroscience research, and are specific to only one child’s brain.

How are Neurodevelopmental Disorders Usually Treated?

Neurodevelopmental Disorders are treated through multiple forms of therapy. Options include medications, cognitive behavioral therapy, speech therapy, and other integrative therapy models.

While medications can be helpful, they generally are used primarily for symptom management, and do not directly address the specific pathway and circuit dysfunction involved in neurodevelopmental disorders. Medications are quite simply not yet specific enough to target only the right dorsolateral prefrontal cortex, or the left basal ganglia, and so on. Medications have their effects wherever a particular neurotransmitter is made or used, and thus tend to promote systemic side effects (39).

How is the NeuroRescue Program Different?

We begin all of our neurodevelopmental NeuroRescue Programs with a thorough assessment of primitive reflexes. We develop a specific protocol of exercises to attenuate any retained reflexes. As the exercises involved are quite simple, and only require compliance, we frequently send the parent home with a series of these to perform at home. If compliance is an issue, we can also perform them in the clinic as intensive therapy.

Once these have been addressed, we move on to top-down processing issues involving the frontal, parietal and temporal lobes, the midbrain, the cerebellum, and the basal ganglia. We identify the impaired systems through examination and neurodiagnostic testing. We usually find that a week or two of intensive therapy working with whatever systems have shown to be struggling is sufficient to bring them back online, get them to start to integrate properly with other pathways, and move your child back onto a more appropriate neurodevelopmental path.

We create unique therapy programs that are specific to each individual. Every NeuroRescue program is tailored to the unique history, examination findings, and neurodiagnostic testing data we acquire during our Discovery Day.

We employ a wide variety of different therapies in the treatment of neurodevelopmental disorders. Every therapy or modality is well validated in current neuroscience research.

Our therapies may include eye movement strategies to improve attention and focus (28), or motor entrainment therapies to improve coordination and cognition (29). In older individuals they may involve specific forms of electrical stimulation (30), or transcranial magnetic stimulation to facilitate improvement in motor learning and coordination (31). They may involve dietary modulation and supplementation strategies (32), or hyperbaric oxygen therapy to reduce repetitive, self-stimulatory and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction (33). They may involve photobiomodulation strategies to reduce irritability and other associated symptoms and behaviors (34). They may involve vestibular rehabilitation exercises to improve balance and postural control (35), or even exercises performed in a virtual reality environment to improve social interaction and cognition (36). They may also involve probiotics and other forms of supplementation to address the inflammatory and dysbiotic aspects of your child’s condition (37).

Every NeuroRescue Program is different. It is impossible to take a cookie-cutter approach to the treatment of a condition as complex as a neurodevelopmental disorder. No two brains are alike, and nor are any of our NeuroRescue Programs.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your condition forward.

Our examination allows us to identify the areas and pathways of your brain that have been impacted by your condition. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

Your NeuroRescue Program allows us to maximize their efficiency and endurance or your relevant neurological systems. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.

Your Next Best Step:

Living with a neurodevelopmental disorder can be challenging, but many of the symptoms can be managed, function can be enhanced, and quality can often be significantly improved. To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.

And remember, it’s never too late to start getting better.