Neurodevelopmental disorders (NDDs) are a set of difficulties that affect the acquisition and development of essential skills, such as language, reading, calculation and attention, and they significantly impact the daily lives of children and their families (International Classification of Diseases: ICD-11, 2018). Almost 20% of children in Catalonia has one of these disorders, which may include, among others, developmental language disorder (DLD), dyslexia, dyscalculia and attention deficit disorder with or without hyperactivity (ADHD) (Bosch et al., 2022).

According to previous studies in other countries, these children experience academic and cognitive difficulties and are also at a higher risk of emotional suffering and mental health problems, such as anxiety and depression (Donolato et al., 2021; Yew & O’Kearney, 2013). Emotional competence, based on identifying, understanding, expressing and regulating emotions towards oneself and others (Beck et al., 2012), has been shown to be directly related to mental health levels (Costescu et al., 2023).
Deepening our comprehension of the well-being and emotional competence of children with neurodevelopmental disorders and their families is vital for understanding and addressing the associated difficulties. 

Based on an innovative approach to studying neurodevelopmental disorders, the project assessed all children in the study in four key developmental areas: reading, calculation, oral language and attention-behaviour. This methodology allows for a more complete and realistic view of how various difficulties or disorders can co-occur within the same child, and how this co-occurrence may affect their learning and development.

Almost three hundred children and their families participated in the project. These included both children with typical development – without difficulties or neurodevelopmental disorders – and children with suspected or diagnosed dyslexia, dyscalculia, developmental language disorder (DLD), or attention deficit disorder with or without hyperactivity (ADHD). 

In order to define the groups, all the children underwent several screening tests for the aforementioned four skills. Those who presented some risk in any of these areas were then assessed using specific standardised diagnostic tests to confirm or rule out a possible neurodevelopmental disorder. The final sample comprised 283 children: 123 (43.5%) with typical development and 160 with one or more of the four neurodevelopmental disorders studied (see Figure 1).

Previous studies indicate a high degree of co-occurrence of these disorders (Büber et al., 2020), as demonstrated by the results of this project, thereby confirming this trend of a high presence of comorbidity in our context: 48% of children have two or more diagnosed disorders.

In terms of the parents who participated in the study, it is notable that 88% were mothers and 12% were fathers. The greater involvement of mothers highlights the fact that responsibility, concern and time dedicated to the participation of children in activities such as this research are still considered to be tasks traditionally attributed to women.





 

In order to assess the emotional well-being of children with or without neurodevelopmental disorders, families were asked to complete the standardised Child Behaviour Checklist (CBCL; Achenbach, 2011) questionnaire, which provided an understanding of their children’s behaviour and emotional issues. This instrument allows various areas of psychological and emotional functioning to be assessed. It includes five main facets: internalising symptoms (such as anxiety, depression and withdrawal), externalising symptoms (such as rule-breaking and aggressive behaviour), social problems, attention problems and thought problems. The results indicate that children with these disorders exhibit greater emotional distress, as evidenced by internalising symptoms such as depression and anxiety and also externalising symptoms such as aggression and rule-breaking, in addition to difficulties in social, attention and cognitive facets. Furthermore, these difficulties tend to increase when a child exhibits more than one disorder (comorbidity). In other words, children with two or more neurodevelopmental disorders exhibit a significantly higher number of emotional problems, particularly in social and attention facets, than children with only one.



Finally, in order to examine the differences between groups in more detail according to emotional suffering scores, an analysis was performed on the number of children who obtained scores equal to or greater than 65 on the CBCL scale. In other words, those considered at risk of one or more mental health disorders. Table 1 shows that a significant number of children have neurodevelopmental disorders, particularly in the facets of anxious/depressed, social problems, thought problems and attention problems. The results also indicate that the number of girls with neurodevelopmental disorders, with risk scores for symptoms of anxious/depressed, somatic complaints and rule-breaking behaviour, is notably higher. 


 

The families completed a self-administered questionnaire (Depression, Anxiety and Stress Scale, or DASS) that helped to assess the frequency and intensity of symptoms of depression, anxiety and stress experienced by the parents. When analysing the results, no significant differences in the level of emotional suffering were observed between families of children with neurodevelopmental disorders and families of children with typical development. However, when the group of families with children who had more than one diagnosed disorder was examined, it was found that they had reported significantly higher levels of emotional suffering, especially depression, than families with children who had only one diagnosed disorder (mean of one diagnosed disorder = 1.51; mean of two or more diagnosed disorders = 3.04; p < 0.05).

 

In order to assess the children’s emotional regulation, the families were given the standardised Emotion Regulation Checklist (ERC), which measures affective lability, intensity, flexibility and emotional appropriateness in different situations. The results show that children with neurodevelopmental disorders have significantly greater difficulty in regulating their emotions than children with typical development, and they express this difficulty by becoming more irritable, manifesting this in the form of tantrums and sudden changes in emotional state. A similar pattern to that of emotional distress was also observed, as the group of children with two or more disorders exhibited significantly higher levels of irritability than those with a single disorder. 

In order to assess the emotional regulation of mothers and fathers, they were asked to complete the standardised, self-administered Difficulties in Emotion Regulation Scale (DERS) questionnaire. This scale provides a global index — higher scores indicating more difficulties — and six subscales that help to assess emotional acceptance, clarity and awareness of emotions, impulse control, constancy of goals and the use of effective emotional regulation strategies. Global emotional regulation difficulties for families of children with comorbid neurodevelopmental disorders are significantly higher (mean of one disorder = 45.3; mean of two or more disorders = 51.6; p < 0.05). When analysing the specific difficulties of these families in terms of emotional regulation, it was found that they experience more difficulty in accepting and maintaining daily activities when feeling overwhelmed.

The high comorbidity observed in neurodevelopmental disorders and the associated emotional and behavioural difficulties demonstrate the need to study these disorders from a comprehensive, multifaceted perspective.

This set of results has major practical implications, as they highlight the importance of conducting exhaustive diagnostic assessments that take into account comorbidity, comprehensive interventions incorporating emotional competence training and support programmes specifically designed for families, paying particular attention to the emotional and caregiving burden mainly experienced by mothers.

The results of this project suggest that the emotional impact on families may be increased by the complexity associated with a comorbidity of disorders, possibly because these children require more attention, resources and adaptations. 
 

This study has some limitations that should be taken into account. Despite the large sample size, it may not be fully representative of the general population, as most of the participating families expressed an existing interest in the field of neurodevelopmental disorders. Furthermore, the data come from self-reported questionnaires, an aspect that may lead to a certain degree of variability associated with the subjective perceptions of these families.

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BOSCH, R.; M. PAGEROLS; C. RIVAS; L. SIXTO; L. BRICOLLÉ; G. ESPAÑOL-MARTÍN; R. PRAT; J. A. RAMOS-QUIROGA; M. CASAS (2022): «Neurodevelopmental disorders among Spanish school-age children: prevalence and sociodemographic correlates», Psychological Medicine, 52(14), 3062-3072. 

BÜBER, A.; Ö BAŞAY; H. ŞENOL (2020): «The prevalence and comorbidity rates of specific learning disorder among primary school children in Turkey», Nordic Journal of Psychiatry, 74(6), 453-460. 

COSTESCU, C.; A. ROSAN; C. DAVID; L. COZMA; A. CALOTA (2023): «The Relation between Cognitive and Emotional Processes in Children and Adolescents with Neurodevelopmental Disorders - A Meta-Analysis», European Journal of Investigation in Health Psychology and Education, 13(12), 2811-2826.

DONOLATO, E.; R. CARDILLO; R., I. C. MAMMARELLA; M. MELBY-LERVÅG (2022): «Research Review: Language and specific learning disorders in children and their co-occurrence with internalizing and externalizing problems: a systematic review and meta-analysis», The Journal of Child Psychology and Psychiatry, 63(5), 507-518.

YEW, S. G. K.; R. O’KEARNEY (2013): «Emotional and behavioural outcomes later in childhood and adolescence for children with specific language impairments: meta-analyses of controlled prospective studies», The Journal of Child Psychology and Psychiatry, 54(5), 516-524.