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Warning signs of NDDs

Main warning signs of neurodevelopmental disorders (NDDs)

Neurodevelopmental disorders can manifest in different ways and at different stages of a child’s life. Remember that every person is unique, and the presence of some of these signs does not necessarily mean there is a diagnosis. However, they may be a reason to consult specialists who can offer guidance and, if necessary, carry out a more comprehensive assessment.

Neurodevelopmental
disorders

Dyslexia

Early Years Education

  • Incorrect production of some speech sounds or a history of speech and language therapy.
  • Poor phonological awareness, with difficulty identifying phonemes within a word.
  • Limited verbal recall, with errors when naming colours, objects or sequences of time (yesterday-today-tomorrow, morning-evening…).
  • Difficulty matching sounds to letters (grapheme-phoneme correspondence).
  • Difficulty automatising verbal sequences such as the days of the week.

Primary Education

Middle Primary (8-10 years)
  • Difficulty retrieving familiar words (lexical retrieval or verbal labelling), such as the names of meals, times of day or the hours.
  • Very syllabic or phonetic reading, with a monotonous intonation.
  • Frequent errors such as omissions, substitutions, inversions or rotations of letters (p/q, b/d, al/la, es/se).
  • Errors are repeated even after they have been corrected.
  • May show nervousness or anxiety when asked to read aloud.
  • Reading comprehension is often preserved if the difficulty is not severe.
  • In some cases, the extra effort required by the mechanics of reading interferes with text comprehension.
  • High incidence of phonologically plausible spelling errors: omission, addition, substitution, inversion or rotation of letters.
  • Difficulty automatising verbal sequences such as the days of the week, the months of the year, the seasons or the alphabet.

Secondary Education (ESO)
and Baccalaureate:

  • Difficulty expressing themselves fluently and clearly.
  • Difficulty finding words (lexical retrieval).
  • A gap between good oral ability and difficulties with written work.
  • Difficulty remembering dates, names, events and subject-specific vocabulary.
  • Slow, non-automatic reading.
  • Difficulty understanding long or complex texts due to the extra effort involved in reading.
  • Many spelling mistakes (both phonologically plausible and arbitrary).
  • Poor written work, with problems with coherence and cohesion.
  • Inconsistent results depending on the subject or type of task
  • Frustration or anxiety about reading or writing.
  • Low academic self-esteem.
  • Avoidance of reading aloud.

Primary Education

Lower Primary (6-8 years)
  • Difficulty retrieving familiar words (lexical retrieval or verbal labelling), such as the names of meals, times of day or the hours.
  • Very syllabic or phonetic reading, with a monotonous intonation.
  • Frequent errors such as omissions, substitutions, inversions or rotations of letters (p/q, b/d, al/la, es/se).
  • Errors are repeated even after they have been corrected.
  • May show nervousness or anxiety when asked to read aloud.
  • Reading comprehension is often preserved if the difficulty is not severe.
  • In some cases, the extra effort required by the mechanics of reading interferes with text comprehension.
  • High incidence of phonologically plausible spelling errors: omission, addition, substitution, inversion or rotation of letters.
  • Difficulty automatising verbal sequences such as the days of the week, the months of the year, the seasons or the alphabet.

Primary Education

Upper Primary (10-12 years)
  • Significant gap between oral and written language skills.
  • Difficulty finding words when speaking, with problems with labelling and lexical retrieval.
  • Discrepancy between reading comprehension and listening comprehension results.
  • Slow reading with errors
  • Difficulty using appropriate intonation and observing pauses and punctuation.
  • Reading comprehension is more preserved than the ability to decode text.
  • High number of arbitrary spelling mistakes.
  • Difficulties with written expression.
  • Reluctance to read aloud, with signs of anxiety or insecurity in front of others.

Other symptoms that
may occur include:

• Reluctance to do reading-related tasks.
• Embarrassment about reading in public.
• Not having enough time to complete written tasks.
• Low academic results in written assessments.
• Low self-esteem

Dyscalculia:

Early years education (4–6 years)

  • Finds it difficult to classify objects according to criteria such as shape or size.
  • Shows confusion with basic concepts of quantity and size: “more than”, “less than”, “bigger”, “smaller”…
  • Difficulty learning the number sequence (skips numbers, puts them out of order…).
  • Difficulty establishing one-to-one correspondence (one object = one number).
  • Errors when identifying and naming numbers below 10
  • Problems recognising numerical symbols (Arabic numerals).
  • Difficulty carrying out simple mental calculations (addition and subtraction up to 5).
  • Limited ability to make simple estimates of small quantities (up to 10).
  • Difficulty immediately recognising the number of dots on a die

Secondary education:

  • Difficulty applying numbers in everyday situations (shopping, timetables, money…).
  • Frequent errors in basic mathematical operations.
  • Arithmetic facts are not automated (addition, subtraction, multiplication, division).
  • Difficulty using estimates or approximations confidently.
  • Lack of strategies for tackling mathematical problems.
  • Difficulty choosing the right operation for a given situation.
  • Limited flexibility in numerical reasoning.
  • Difficulty converting units of measurement (length, weight, time…).
  • Confusion with measurement systems or unfamiliar formats.
  • Aversion to or lack of motivation for mathematics.
  • Anxiety or becoming stuck when faced with numerical tasks.
  • Persistent difficulties documented in school reports, particularly in mathematics.

Primary education:

  • Difficulty recognising small quantities without counting.
  • Frequently uses fingers to count.
  • Difficulty associating quantities with the written form of a number.
  • Difficulty counting backwards.
  • Frequent errors when numbers are dictated.
  • Incorrect use of signs.
  • Difficulty memorising and automating multiplication tables.
  • Uncertainty when choosing which operation to use in a problem.
  • Difficulty doing mental calculations or estimating with large numbers (hundreds, thousands).
  • Works very hard and needs more time to complete maths exercises.
  • Difficulty ordering numbers according to their magnitude on a number line.
  • Errors in arranging digits into units, tens and hundreds.
  • Difficulty breaking numbers down into their component parts
  • Difficulty learning and understanding the time.
  • Consistently low results in mathematics in school reports.
  • Aversion, anxiety or becoming stuck when faced with mathematical activities.

ADHD

Difficulty sustaining attention

  • Distractibility and being easily sidetracked by irrelevant stimuli.
  • Tendency to make careless mistakes, such as in schoolwork.
  • Difficulty organising and completing tasks.
  • Difficulty paying attention to details.
  • Frequent forgetfulness in daily activities.
  • Difficulty listening to and following instructions.
  • Repeatedly losing items, such as toys or school exercise books.
  • Tendency to avoid tasks that require sustained mental effort.

Excessive motor and/or cognitive activity (hyperactivity)

  • Excessive motor activity.
  • Difficulty remaining seated or still, particularly in quiet environments.
  • Tendency to play with their hands or feet, fidget in their seat, run or climb when it is inappropriate.
  • Excessive or uncontrolled talking.

Lack of behavioural control (impulsivity)

  • Tendency to interrupt other people.
  • Responds immediately without having fully listened to the question.
  • Difficulty waiting their turn.
  • Tendency to act without thinking about the consequences.
  • Limited awareness of danger.

Developmental language
disorder (DLD):

Early years education (first cycle):

0–3 months:

  • Little reaction to voices or sounds.
  • Smiles infrequently or only occasionally when spoken to.
  • Limited or infrequent eye contact.

3–4 months:

  • Very few or little variety in vocal sounds.
  • Limited communicative intent.
  • Little reaction to noises, voices or music.

4–6 months:

  • Does not follow sounds with their eyes.
  • Very limited or no syllable-like sounds.

6–8 months:

  • Turns their head infrequently towards where sounds come from.
  • Reduced response when spoken to.
  • Little or underdeveloped babbling.

8–12 months:

  • Little babbling or few strings of sounds.
  • Limited imitation of speech sounds.
  • Limited use of sounds or gestures to attract or maintain other people’s attention.
  • Does not respond to their name  
  • Limited understanding of basic, very common words.

18–24 months:

  • Limited understanding of simple phrases such as “don’t touch”.
  • Produces fewer than 10 intelligible words.
  • Does not respond with “no” or shake their head to indicate negation.
  • Does not point to show another person what they want.
  • Does not respond to simple questions with words or gestures.

2–3 years:

  • Minimal interaction and lack of communicative intent.
  • May show regression or stagnation in language development.
  • Produces fewer than 50 words.
  • Does not form two-word phrases.
  • Does not follow simple instructions.
  • Does not repeat words heard during a conversation.
  • Does not develop symbolic or pretend play.
  • Approximately 50% of their speech should be intelligible at this age.

3–4 years

  • Limited understanding of what is said.
  • Difficulty following instructions with two or three steps.
  • Produces very short phrases, of no more than three words.
  • Close family members understand less than half of what is said.

4–5 years

  • Limited understanding of spoken language, with difficulty following or remembering verbal instructions.
  • Very limited vocabulary, both in comprehension and expression.
  • Difficulty learning new words, even after repeated exposure.
  • Uses very basic grammatical structures, with short, simple phrases.
  • Difficulty recounting stories in an ordered and coherent way.
  • Slow to retrieve the words they want to say, with pauses or incorrect words.

5–6 years

  • Instructions often need to be repeated several times to ensure they are understood correctly.
  • Difficulty understanding spoken narratives, especially when they are long or complex.
  • Phonological errors in long or less familiar words.
  • Slow to retrieve the words they want to say, which can lead to pauses or incorrect expressions.
  • Limited vocabulary, reducing the richness and precision of their speech.
  • Difficulty planning spoken discourse, resulting in poorly structured or incoherent narratives.
  • Disordered or incomplete sentences, with words or conjunctions omitted.
  • Difficulties with phonological awareness, such as isolating, identifying or manipulating sounds within words.
  • Difficulty establishing the relationship between sounds and letters (grapheme–phoneme correspondence), which can affect early reading and writing.

Primary education:

6–10 years

  • Uses a limited vocabulary, with a restricted range of words and expressions.
  • Difficulty understanding uncommon, abstract or subject-specific academic words.
  • Grammatical errors, particularly with verb tenses, agreement and sentence structure.
  • Difficulty following long verbal instructions or those with multiple steps.
  • Interprets language literally, with limited understanding of double meanings, irony or communicative intent.
  • Difficulty organising discourse coherently, whether narrating, describing or explaining ideas.
  • Ineffective participation in conversations, with difficulty taking turns, staying on topic or avoiding repetition.

Secondary education:

Over 12 years

  • Disorganised speech, with difficulty structuring and expressing ideas clearly and coherently.
  • Limited vocabulary, with difficulty incorporating uncommon words or new terms (neologisms).
  • Morphosyntactic confusions, particularly in more complex structures, such as changes to sentence order, incorrect use of verb tenses or incomplete sentences.
  • Phonological difficulties with long or complicated (polysyllabic) words.
  • Literal understanding of language, with difficulty understanding double meanings, irony, jokes or metaphors.
  • Limited pragmatic competence, with difficulty adapting speech according to the

    • context or the interlocutor.

  • Insecurity or avoidance in situations involving public speaking, such as presentations, debates or answering questions in class.
  • Difficulties with reading comprehension, especially with texts containing more complex language or difficult syntactic structures.
  • Problems following long or ambiguous instructions, especially if they are not presented clearly or visually.

Autism spectrum disorder (ASD):

First cycle of early childhood education

6 months:

  • Little or no interest in social smiling or caregivers.
  • Little response to eye contact or anticipation of being picked up.
  • High levels of irritability and passivity.

9 months:

  • Limited response to and interaction with adults.
  • Few behaviours involving sharing or showing toys.
  • Little variety in facial expressions and vocalisations.
  • Little attention to social routines such as peekaboo or nursery rhymes.
  • High levels of irritability and passivity.

12 months:

  • Little or no babbling or vocalisation.
  • Little back-and-forth communication with caregivers.
  • Few sharing behaviours (showing, pointing to or handing over objects).
  • Limited use of gestures such as clapping or waving.
  • No response, or an inconsistent response, to their name.

 18 months:

  • A developmental “interruption” may occur, with signs becoming more apparent.
  • Reduced interest in interacting with and responding to adults.
  • Does not start using single words or learn new ones.
  • Vocalisations are not directed at anyone, or there are prolonged periods of silence.
  • Does not respond to instructions (which may seem like deafness).
  • Does not follow where others are looking or point to request things.
  • May show discomfort with certain sounds (covering their ears).

24 months:

  • Language development does not follow the typical pattern.
  • Does not respond to instructions, or responds inconsistently.
  • Very marked atypical interests.
  • Repetitive movements or unusual postures when excited.
  • Difficulty adapting to changes in routine.
  • Does not imitate adults.
  • Does not engage in pretend play with dolls or figurines.
  • Does not interact with other children of the same age.

Secondary education

12–16 years

  • Intense interest in specific topics, such as collecting objects or memorising facts, with little interest in other people’s topics.
  • Need to see particular people or places repeatedly.
  • Difficulty coping with changes or disruptions to routines.
  • Repetitive or unexpected movements in social situations.
  • High sensitivity to sensory stimuli and a need to seek continuous stimulation.
  • Sleep problems or irregular sleeping habits.
  • Eating difficulties, such as very specific preferences.
  • Dependence on electronic devices or social media.
  • Anxiety, sadness or feelings of loneliness due to social difficulties.
  • Difficulty managing frustration and behaviour.
  • Difficulty organising themselves and managing their time at school.
  • Vulnerability to bullying and difficulty recognising situations involving rejection.

Second cycle of early childhood education

3–6 years:

  • Difficulty with verbal expression and comprehension.
  • Temper tantrums and irritability may have increased.
  • May need rituals to avoid becoming upset.
  • Shows very little interest in interacting with children of the same age.
  • Limited eye contact or eye contact focused strongly on particular interests.
  • Difficulty learning through imitation and with joint attention.
  • Intense interest in certain objects or topics.
  • Difficulty with interactive play, but may engage in parallel play.
  • Difficulty regulating emotions.
  • Differences in sensory sensitivity (hypersensitivity or hyposensitivity).
  • Adherence to routines and routes.
  • Difficulty learning basic skills (e.g. toilet training).
  • Difficulty with eating and sleeping.

Primary education

6–8 years:
Social communication

  • Language may be limited, both in expression and comprehension.
  • It is often difficult to maintain a fluent conversation: they interrupt, talk too much or do not respect turn-taking.
  • It is very difficult for them to talk about topics that are not of personal interest.
  • They do not always interpret non-verbal cues such as gestures or tone of voice correctly.
  • Eye contact may be limited or difficult to sustain.
  • They more often socialise with people who are older or younger than they are than with their peers.
  • Play is usually solitary or involves wanting to control the activity.
  • It may be difficult to establish reciprocal or lasting friendships.
  • Social interest may fluctuate between a strong desire for interaction and a need to be alone.
  • New social situations may cause discomfort or anxiety.

Behaviour

  • They often show rigidity around rules and difficulty adapting to change.
  • Very intense interests in hobbies or objects may develop, sometimes unusual ones.
  • Actions or routines are repeated, such as lining up objects or following specific patterns.
  • Extreme (or very low) sensitivity to sensory stimuli such as sounds, lights or pain may occur.
  • Unusual body movements may be observed.
  • Eating- and sleep-related routines may be very rigid and interfere with everyday life.
  • Traits associated with ADHD, such as impulsivity, inattention or hyperactivity, may be present.

9–12 years
Social communication:

  • Difficulty maintaining eye contact.
  • Problems interacting and playing with peers, which may worsen with age.
  • They may find it difficult to talk about topics outside their interests, or may try to imitate others without enjoying it, which causes them stress.
  • They prefer to play alone or try to control the game, displaying unusual behaviours.
  • Their interest in socialising varies: they may go from wanting lots of company to withdrawing.
  • Difficulty understanding non-verbal social cues, such as body language or tone of voice.
  • Problems understanding double meanings.
  • Immature or excessively adult behaviour.
  • Anxiety or sadness in social or school situations.
  • Behavioural and emotional dysregulation.

Behaviour:

  • Excessive obsession with specific hobbies or objects.
  • Repetitive behaviours related to routines or interests.
  • Exaggerated or very low sensitivity to sensory stimuli (sounds, smells, pain).
  • Unusual body movements.
  • Very fixed eating and sleeping routines and habits.
  • Difficulties related to ADHD (impulsivity, inattention, hyperactivity) and learning (reading and writing).
  • Possible comorbidities with other mental health conditions.