Psychiatry: disorder groups
Neurodevelopmental disorders (ADHD, autism, intellectual disability)
Neurodevelopmental disorders start in early development and affect learning, attention, communication or behaviour for life: chiefly ADHD, autism and intellectual disability. Psychiatrists diagnose and treat them, and increasingly see adults never diagnosed as children.
Depth by stage, Pre-U → Consultant (details)
What is it?
Neurodevelopmental disorders arise from differences in how the brain develops. Attention deficit hyperactivity disorder (ADHD) involves persistent inattention and/or hyperactivity and impulsivity. Autism spectrum disorder involves differences in social communication with restricted, repetitive interests or behaviours and sensory sensitivities. Intellectual disability (ICD-11: disorder of intellectual development) means significant limits in intellectual and adaptive functioning.
Other conditions in this group include developmental learning disorders (such as dyslexia), developmental speech and language disorders, developmental motor coordination disorder and tic disorders including Tourette syndrome.
These conditions often continue into adulthood. Many adults, especially women, are diagnosed late after years of struggling at school or work, often with depression or anxiety on top.
Why does a psychiatrist need it?
Child psychiatrists diagnose and treat these conditions, but adult psychiatrists increasingly assess adult ADHD and autism and must recognise them behind mood, anxiety and personality presentations. People with intellectual disability have higher rates of mental illness, which presents differently and needs adapted care.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns child development milestones and basic genetics of developmental conditions.
- ClinicalUnderstandsRecognises ADHD, autism and intellectual disability in paediatric and psychiatry postings.
- HousemanshipAwareMeets children with developmental conditions in paediatrics and communicates with families.
- Medical officerUnderstandsRecognises neurodevelopmental conditions in adult patients and refers for assessment.
- Psych traineeAppliesAssesses and manages ADHD, autism and intellectual disability in children and adults with supervision.
- Specialist / consultantMasters / TeachesChild and adolescent or intellectual disability subspecialists lead diagnosis and services.
What are the key topics?
Conditions
- Attention deficit hyperactivity disorder (inattentive, hyperactive-impulsive, combined presentations)
- Autism spectrum disorder (with or without intellectual or language impairment)
- Disorders of intellectual development (mild, moderate, severe, profound)
- Developmental learning disorders (reading, writing, mathematics)
- Developmental speech or language disorders
- Tic disorders and Tourette syndrome
- Developmental motor coordination disorder
Causes
- High heritability, especially for ADHD and autism
- Genetic syndromes: Down syndrome, fragile X syndrome, others
- Prenatal factors: alcohol (fetal alcohol spectrum disorder), infections, prematurity
- Brain development and connectivity models
Assessment
- Developmental history from parents and school reports
- Rating scales such as Conners or Vanderbilt for ADHD and the ADOS-2 or ADI-R for autism
- Cognitive and adaptive testing, often with clinical psychologists
- Hearing, vision and physical examination; genetic testing where indicated
- Comorbidities: anxiety, depression, epilepsy, sleep problems
Management
- Stimulants (methylphenidate, amphetamine-based) and non-stimulants (atomoxetine, guanfacine) for ADHD
- Parent training and behavioural approaches
- Educational support; special education in Malaysia
- Speech, occupational and behavioural therapies for autism
- Mental health care adapted for intellectual disability; avoiding overuse of antipsychotics
- Transition from child to adult services
How is it learned and assessed?
- Paediatrics and psychiatry postings
- Child and adolescent psychiatry rotation during specialist training
- MMed Part II; MRCPsych Paper A (development) and Paper B; CASC (e.g. explaining ADHD medication to a parent)
Typical textbooks and resources
- Rutter's Child and Adolescent Psychiatry — Wiley-Blackwell
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- The Maudsley Prescribing Guidelines in Psychiatry — Wiley (ADHD and autism sections)
- NICE guidance on ADHD and autism — NICE (UK)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Can adults have ADHD?
Yes. ADHD starts in childhood, but symptoms often continue into adulthood. Many adults are diagnosed later after years of difficulties with organisation, focus and impulsivity.
Is autism a mental illness?
Autism is a neurodevelopmental condition, a different way the brain develops. It is not a mental illness in itself, though autistic people may have higher rates of anxiety and depression, which psychiatrists can treat.