Expert Neurological Insights for ADHD Concerns at Cadabam's CDC

Why Consult a Cadabam’s Pediatric Neurologist for ADHD Concerns?

Navigating concerns that resemble ADHD requires careful evaluation, and in specific circumstances, consulting a Pediatric Neurologist for ADHD evaluation at Cadabam’s CDC offers critical advantages:

• Deep Expertise in the Developing Nervous System: Pediatric Neurologists are medical doctors (MDs) who undergo extensive residency training in Neurology followed by specialized fellowship training in Child Neurology. Their entire focus is on the developing brain, spinal cord, peripheral nerves, and muscles. This specialized knowledge is paramount when symptoms might have an underlying neurological basis beyond typical ADHD.
• Mastery in Differential Diagnosis of Neurological Mimics: Perhaps the most critical reason to consult our Pediatric Neurologists for ADHD is their unparalleled skill in ruling out conditions mimicking ADHD . They are trained to recognize subtle signs and symptoms of disorders affecting the nervous system (like certain types of epilepsy, sleep disorders, or effects of brain injury) that can present with behaviours easily mistaken for ADHD. Accurate diagnosis is the foundation of effective treatment.
• Experience with Complex Neurological Comorbidities: ADHD frequently co-exists with other conditions. Our Pediatric neurologist for ADHD with co-existing neurological disorders brings essential expertise in managing this complexity. Conditions like epilepsy, tic disorders/Tourette Syndrome, certain neurogenetic syndromes (e.g., Neurofibromatosis Type 1), migraines, or movement disorders require careful management, especially concerning potential interactions with ADHD treatments.
• Judicious Use and Expert Interpretation of Neurodiagnostic Tools: While not routine for ADHD, certain situations may warrant neurodiagnostic tests. Our Pediatric Neurologists are experts in determining if an EEG (electroencephalogram) or neuroimaging (MRI/CT scan) is truly necessary based on clinical suspicion, and critically, they possess the expertise to interpret these complex results accurately within the clinical context.
• Collaborative Care Within Cadabam’s Integrated Team: Our Pediatric Neurologists for ADHD do not work in isolation. They are key members of the Cadabam’s multidisciplinary team, collaborating closely with our Child Psychiatrists, Psychologists, Neuropsychologists, Occupational Therapists, Speech-Language Pathologists, Special Educators, and other specialists. This ensures neurological findings are integrated into a comprehensive understanding and management plan for the child.

Consulting a Cadabam’s Pediatric Neurologist for ADHD concerns provides access to specialized medical expertise focused on the nervous system, crucial for accurate differential diagnosis, managing complex neurological comorbidities, and ensuring a truly holistic evaluation when specific red flags are present.

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Identifying the Need: When to consult a pediatric neurologist for suspected ADHD

While many children with ADHD are appropriately diagnosed and managed by primary care physicians, psychiatrists, or psychologists, certain signs or circumstances strongly suggest that understanding when to consult a pediatric neurologist for suspected ADHD is crucial. Referral to a Pediatric Neurologist for ADHD evaluation is often recommended if the following red flags are present:

Atypical Symptom Presentation:

• Sudden Onset or Regression: Symptoms appearing abruptly, or a sudden worsening of previously stable symptoms, especially if associated with illness or injury.
• Episodic Symptoms: Behaviours or attention lapses that occur in distinct episodes, particularly staring spells, periods of unresponsiveness, confusion, or automatic behaviours ("absence spells" or complex partial seizures).
• Symptoms Not Fitting Classic ADHD Patterns: Unusual behavioural manifestations or cognitive difficulties that don't align well with typical ADHD presentations.

Presence of Seizures or Suspected Seizure Activity:

• Any event involving loss of consciousness, involuntary movements (jerking, stiffening), staring spells with unresponsiveness, unexplained confusion, or sensory changes definitely warrants a neurological evaluation. Remember, some seizures (like absence seizures) can be subtle and look just like inattention.

Significant Global Developmental Delays:

• Marked delays across multiple areas of development – significant motor milestones (sitting, walking), language acquisition, and cognitive function – alongside attention problems suggest a potentially broader underlying neurological or genetic condition that requires investigation by a Pediatric Neurologist for ADHD expert.

Presence of Specific Motor Abnormalities:

• Significant Tics: Frequent, complex, or bothersome motor or vocal tics (suggestive of Tic Disorders or Tourette Syndrome).
• Marked Coordination Difficulties: Clumsiness significantly impacting function beyond typical levels (ruling out underlying neurological causes vs. primary Developmental Coordination Disorder).
• Muscle Weakness or Tone Abnormalities: Hypotonia (low tone) or hypertonia (high tone/stiffness).
• Abnormal Gait or Movements: Unusual walking patterns, tremors, chorea, or other involuntary movements.

Associated Neurological Symptoms:

• Frequent or Severe Headaches: Especially if associated with changes in vision, vomiting, or worsening attention/behaviour.
• Dizziness or Vertigo.
• Vision Changes: Blurred vision, double vision not explained by eye exams.
• Significant Sleep Disturbances: Beyond typical childhood sleep issues, such as suspected sleep apnea or severe restless legs syndrome.

Relevant Medical or Family History:

• Known Neurological Condition: A pre-existing diagnosis like epilepsy, cerebral palsy, neurofibromatosis, etc.
• Strong Family History: Multiple close relatives with specific neurological disorders like epilepsy, Tourette Syndrome, Huntington's disease, or diagnosed neurogenetic conditions.
• History of Significant Head Injury, Brain Infection, or Premature Birth with Complications.

Lack of Response to Standard ADHD Treatment:

• If a child has received an adequate trial of evidence-based ADHD treatments (medication and/or behavioural therapy) managed by appropriate specialists (like a Child Psychiatrist) without significant improvement, consulting a Pediatric Neurologist for ADHD is prudent to reconsider the diagnosis and rule out missed underlying neurological factors.

If any of these red flags are present, understanding when to consult a pediatric neurologist for suspected ADHD and seeking their specialized evaluation can be crucial for accurate diagnosis and appropriate management.

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The Neurologist's Unique Focus in ADHD Evaluation

When a Pediatric Neurologist for ADHD evaluates a child, their primary lens is focused on the health and functioning of the brain and nervous system. Their unique contribution lies in systematically considering and investigating neurological explanations for the presenting symptoms or managing known neurological comorbidities alongside ADHD.

A. Unmasking Look-Alikes: Role of pediatric neurologist in ruling out conditions mimicking ADHD

The role of pediatric neurologist in ruling out conditions mimicking ADHD stems from their deep knowledge of neurological disorders. Misdiagnosing a neurological condition as solely ADHD can lead to delayed appropriate treatment and potentially poor outcomes. The neurologist meticulously considers:

Seizure Disorders (Epilepsy):

• Absence Seizures: These brief episodes (typically 5-15 seconds) involve sudden staring, unresponsiveness, and momentary cessation of activity. They can occur many times a day and are easily mistaken for daydreaming or inattention characteristic of ADHD-Inattentive type. Semantic keyword: absence seizures.
• Complex Partial Seizures: Originating in a specific brain area, these can cause altered awareness, confusion, automatic behaviours (lip-smacking, fumbling), or unusual sensations, potentially mimicking behavioural changes or attentional lapses.
• How Neurologists Investigate: Detailed history focusing on specific descriptions of "spells," triggers, duration, and post-event state. An EEG (electroencephalogram) is the primary tool to detect abnormal brain wave patterns indicative of seizures.

Sleep Disorders:

• Obstructive Sleep Apnea (OSA): Interrupted breathing during sleep leads to poor sleep quality, causing daytime fatigue, irritability, difficulty concentrating, and hyperactivity – symptoms that heavily overlap with ADHD.
• Restless Legs Syndrome (RLS) / Periodic Limb Movement Disorder (PLMD): Urges to move the legs, especially at rest, and involuntary leg movements during sleep can disrupt sleep and lead to daytime ADHD-like symptoms.
• How Neurologists Investigate: Detailed sleep history, physical exam, potential referral for a sleep study (polysomnography).

Tic Disorders / Tourette Syndrome:

• Motor and Vocal Tics: Sudden, rapid, recurrent, non-rhythmic movements or vocalizations (e.g., eye blinking, sniffing, throat clearing, complex gestures or phrases). While tics themselves can be distracting, the effort required to suppress tics often consumes significant mental energy, appearing as inattention or difficulty focusing on tasks. Semantic keyword: tic disorders / Tourette syndrome.
• How Neurologists Investigate: Clinical history and observation during the neurological exam are key. ADHD and tic disorders frequently co-exist, requiring careful management guided by a neurologist or psychiatrist experienced in both.

Effects of Medications:

Certain medications used for other conditions (e.g., some asthma medications, antihistamines, anticonvulsants) can sometimes cause side effects like hyperactivity, irritability, or sedation that might be confused with ADHD symptoms. The neurologist reviews all medications.

Rare Genetic or Metabolic Disorders:

Some inherited conditions affecting brain development or metabolism can present with cognitive difficulties, learning problems, and behavioural changes including ADHD-like symptoms. Neurologists consider these based on developmental history, physical exam findings (dysmorphic features), and family history. Genetic testing may be recommended in specific cases. Semantic keyword: neurogenetic disorders.

Post-Concussion Syndrome / Traumatic Brain Injury (TBI):

Attention problems, slowed processing speed, irritability, and fatigue can persist after a head injury and mimic ADHD symptoms. A detailed injury history is crucial.

Other Mimics:

Less commonly, conditions like certain infections affecting the brain, autoimmune disorders, or structural brain abnormalities might present with relevant symptoms.

The systematic approach of a Pediatric Neurologist for ADHD in considering these mimics ensures that treatable underlying neurological conditions are not missed.

B. Managing Complexity: Pediatric neurologist for ADHD with co-existing neurological disorders

When ADHD genuinely co-exists with a known neurological condition, management requires careful coordination and specialized knowledge, making the Pediatric neurologist for ADHD with co-existing neurological disorders indispensable.

Common Neurological Comorbidities with ADHD:

• Epilepsy: Children with epilepsy have a higher rate of ADHD, and vice versa. Managing both requires careful consideration. Semantic keyword: epilepsy.
• Tic Disorders/Tourette Syndrome: Very high comorbidity rate with ADHD.
• Headaches/Migraines: Frequent headaches can impact attention and functioning.
• Neurogenetic Syndromes: Conditions like Neurofibromatosis Type 1 (NF1), Tuberous Sclerosis Complex (TSC), Fragile X syndrome often have associated ADHD symptoms.
• Cerebral Palsy (CP): ADHD symptoms can co-occur in children with CP.
• Developmental Coordination Disorder (DCD): Often co-occurs and may share some underlying neurological mechanisms.

The Neurologist's Specific Role in Co-Management:

• Understanding Bidirectional Influences: Assessing how the neurological condition might worsen ADHD symptoms (e.g., frequent seizures disrupting attention networks) or how ADHD might impact management of the neurological condition.
• Coordinating Medication Management: This is critical. The neurologist understands:
  • Potential impact of ADHD medications (especially stimulants) on seizure threshold or tics (though often manageable).
  • Potential cognitive side effects of some anti-epileptic or other neurological medications that could worsen attention.
  • Drug-drug interactions between neurological medications and ADHD medications. They often work closely with the Child Psychiatrist to select the safest and most effective treatments for both conditions. Semantic keyword: comorbidity.
• Monitoring Neurological Status: Tracking the primary neurological disorder while ADHD is being treated.
• Providing Holistic Neurological Care: Addressing all aspects of the child's neurological health within the context of their ADHD.

Managing ADHD alongside epilepsy, Tourette's, or other brain-based disorders requires the specialized expertise of a Pediatric neurologist for ADHD with co-existing neurological disorders to ensure safe, effective, and integrated care.

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The Consultation Process: What happens during a pediatric neurological evaluation for ADHD?

Understanding what happens during a pediatric neurological evaluation for ADHD? can alleviate anxiety for families. While incorporating elements similar to other evaluations, the neurologist's assessment has distinct components focused on the nervous system:

Comprehensive History Taking (Neurological Focus):

While covering general development, the Pediatric Neurologist for ADHD will delve deeper into:

• Prenatal & Birth History: Any complications during pregnancy or delivery (e.g., prematurity, infection, hypoxia).
• Detailed Developmental Milestones: Particularly focusing on motor milestones (sitting, crawling, walking – timing and quality) and language development.
• Detailed Symptom Description: Specific focus on the nature of any "spells" or unusual events – triggers, duration, appearance, responsiveness during/after, frequency. Careful questioning about staring episodes, involuntary movements, etc.
• Review of Systems: Asking about headaches, dizziness, vision changes, numbness/tingling, weakness, sleep patterns, bowel/bladder function.
• Family Neurological History: Detailed inquiry about epilepsy, tics, migraines, movement disorders, genetic conditions, learning disabilities, or psychiatric conditions in close relatives.

Detailed Neurological Examination:

This is the cornerstone distinguishing the neurological evaluation. It's a hands-on assessment of nervous system function, typically including:

• Mental Status: Brief assessment of alertness, orientation, language, attention (observed during exam).
• Cranial Nerves (I-XII): Testing functions like smell, vision (visual fields, acuity check), eye movements, facial sensation and movement, hearing, swallowing, tongue movement.
• Motor System:
  • Strength: Testing muscle power in limbs.
  • Tone: Assessing muscle resistance (low tone/hypotonia, high tone/spasticity).
  • Coordination: Finger-to-nose test, heel-to-shin test, rapid alternating movements.
  • Gait: Observing walking pattern (including heel walk, toe walk, tandem walk).
  • Reflexes: Testing deep tendon reflexes (e.g., knee jerk).
• Sensory System: Testing response to light touch, pinprick, vibration, position sense (less detailed unless specific concerns).
• Observation for Involuntary Movements: Watching carefully for tics, tremors, chorea, or other abnormal movements at rest or with action.
• Head Circumference Measurement: Comparing to age norms.
• Physical Examination: Looking for specific physical signs (dysmorphic features, skin findings like café-au-lait spots associated with NF1) that might suggest an underlying neurogenetic syndrome. Semantic keyword: neurological examination / neuro exam.

Review of External Records:

Similar to other specialists, reviewing previous medical records, psychological/educational testing, school reports, and parent/teacher rating scales to get a complete picture.

Consideration and Potential Ordering of Neurodiagnostic Testing (Selective):

Based on history and exam findings, the Pediatric Neurologist for ADHD decides if further testing is warranted. This is not routine for uncomplicated ADHD evaluation.

EEG (Electroencephalogram):

• Purpose: Records electrical activity in the brain via electrodes placed on the scalp. Primarily used to detect abnormal patterns suggestive of seizures/epilepsy, especially if absence seizures or other seizure types are clinically suspected based on the history of "spells." Semantic keyword: EEG / brain waves.
• Process: Usually involves lying quietly, sometimes with eyes closed, sometimes with stimuli like flashing lights (photic stimulation) or deep breathing (hyperventilation) to provoke abnormalities. Typically painless.

Neuroimaging (MRI or CT Scan):

• Purpose: Provides detailed pictures of the brain structure. Reserved for situations with specific red flags like focal findings on neurological exam, significant developmental regression, intractable headaches, suspected structural abnormality, or history suggesting brain injury. MRI is generally preferred for detail unless urgency dictates CT. Semantic keyword: MRI / neuroimaging.
• Process: Involves lying still inside a scanner; MRI can be long and noisy, sometimes requiring sedation for young children.
• Other Tests (Less Common): Genetic testing, metabolic testing, or sleep studies might be recommended based on specific clinical suspicions.

Feedback and Recommendations:

The neurologist synthesizes all findings.

• Discusses diagnostic conclusions: confirming or refuting suspected neurological conditions, providing opinion on ADHD diagnosis from their perspective (often deferring primary ADHD diagnosis to psychiatry/psychology unless managing comorbidities).
• Provides recommendations for:
  • Treatment of any identified neurological condition.
  • Further testing if needed.
  • Referrals back to or coordination with other specialists (Psychiatrist, Psychologist, etc.).
  • Potential implications for ADHD management (e.g., medication choices if epilepsy co-exists).

Understanding what happens during a pediatric neurological evaluation for ADHD? highlights its specialized nature, focused on meticulously assessing the nervous system to ensure diagnostic accuracy and appropriate care pathways.

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Clarifying Medical Roles: Neurologist vs. Psychiatrist for ADHD diagnosis and treatment

A common point of confusion for families is understanding the Neurologist vs. Psychiatrist for ADHD diagnosis and treatment . Both are medical doctors, but their specialization and primary roles in ADHD care differ significantly, although collaboration is frequent and essential.

Pediatric Neurologist:

• Training: Medical Degree (MD/DO) → Residency in Neurology → Fellowship in Child Neurology.
• Primary Focus: Disorders of the Nervous System – brain, spinal cord, nerves, muscles. Expertise lies in conditions like epilepsy, migraines, tics/Tourette's, movement disorders, neuromuscular diseases, neurogenetic syndromes, effects of brain injury.
• Diagnostic Tools: Comprehensive Neurological History, detailed Neurological Examination, EEG, Neuroimaging (MRI/CT), genetic testing, lumbar puncture (rarely for ADHD context).
• ADHD Role:
  • Crucial for Differential Diagnosis: Primarily involved when to consult a pediatric neurologist for suspected ADHD due to red flags suggesting a neurological mimic (e.g., seizures, atypical symptoms). Their main role is often to rule out conditions mimicking ADHD.
  • Managing Co-existing Neurological Disorders: Expert management when ADHD co-occurs with conditions like epilepsy, Tourette's, etc. (Pediatric neurologist for ADHD with co-existing neurological disorders).
  • Consultative Input on Diagnosis: Provides expert opinion if neurological factors are contributing to the clinical picture.
  • Medication Management: May manage ADHD medications, especially when co-managing epilepsy or tic disorders where interactions are a key concern, often in collaboration with psychiatry.

Child Psychiatrist:

• Training: Medical Degree (MD/DO) → Residency in Psychiatry → Fellowship in Child & Adolescent Psychiatry.
• Primary Focus: Mental, Emotional, and Behavioral Disorders. Expertise lies in diagnosing and treating conditions defined in the DSM (like ADHD, anxiety, depression, ODD, bipolar disorder, psychosis, ASD), using a biopsychosocial framework. Masters of psychopharmacology for mental health conditions.
• Diagnostic Tools: Comprehensive Clinical Interview (patient and parent), Rating Scales, adherence to DSM criteria, review of psychological testing.
• ADHD Role:
  • Often Primary Diagnostician: Frequently provides the primary medical diagnosis of ADHD in cases without significant neurological red flags.
  • Primary Medication Manager: Typically manages stimulant and non-stimulant medications specifically for ADHD and co-occurring mental health conditions. Decides when to consult... for ADHD medication based on symptom severity and impairment.
  • Addressing Co-occurring Mental Health Conditions: Expert in managing anxiety, depression, ODD, etc., alongside ADHD (Child psychiatrist for ADHD and co-occurring conditions - mental health focus).
  • Therapeutic Input: May provide therapy or collaborates closely with psychologists/counsellors providing therapy.

Collaboration is Key:

The distinction between Neurologist vs. Psychiatrist for ADHD diagnosis and treatment highlights their complementary expertise.

• A child might see a Child Psychiatrist first for evaluation and management of ADHD. If red flags arise or treatment fails, referral to a Pediatric Neurologist may occur for differential diagnosis or comorbidity assessment.
• Conversely, a child might see a Pediatric Neurologist first for seizures or tics, who then identifies co-occurring ADHD symptoms and either manages them or refers to/collaborates with a Child Psychiatrist.

At Cadabam's CDC, our Neurologists and Psychiatrists work in close partnership, ensuring seamless communication and leveraging each specialty's strengths for optimal patient care.

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Meet Our Cadabam's Pediatric Neurology Experts

Cadabam’s CDC is proud to include highly qualified and experienced Pediatric Neurologists for ADHD evaluation and care as part of our comprehensive team. Our specialists are dedicated to providing meticulous neurological assessment when needed for children presenting with attention or behavioural concerns.

Credentials and Board Certification:

Our Pediatric Neurologists hold Medical Degrees (MD or equivalent) and have completed accredited residency programs in Neurology, followed by specialized fellowship training in Child Neurology. They are typically board-certified by relevant national boards in Neurology with Special Qualification in Child Neurology, signifying the highest level of expertise in diagnosing and treating neurological disorders in children and adolescents.

Extensive Clinical Experience:

Our team possesses significant experience evaluating children with a wide range of developmental and neurological concerns, including those where ADHD is suspected or co-exists with other conditions. They are skilled in identifying subtle neurological signs and interpreting complex clinical pictures.

Specialized Interests:

Within our team, neurologists may have particular areas of interest relevant to ADHD comorbidities, such as epilepsy and its cognitive/behavioural effects, tic disorders and Tourette Syndrome management, neurogenetic conditions, or headache management in children.

Commitment to Careful Evaluation:

Our neurologists understand the importance of thoroughness when evaluating ADHD-like symptoms, prioritizing accurate diagnosis and avoiding premature conclusions. They utilize diagnostic tools like EEG or imaging judiciously, based on clear clinical indications.

Expert Insights from Our Team:

• Quote 1 (Cadabam's Pediatric Neurologist): "A key part of our role...in ruling out conditions mimicking ADHD involves a detailed neurological exam and, when indicated, interpreting tests like EEG. Distinguishing absence seizures from inattention is critical for ensuring the child gets the right treatment – anticonvulsants, not stimulants in that case."
• Quote 2 (Cadabam's Pediatric Neurologist): "For a pediatric neurologist for ADHD with co-existing neurological disorders like Tourette's, careful management is essential. We need to balance ADHD treatment benefits with potential impacts on tics, often coordinating closely with the child psychiatrist on medication strategies."
• Quote 3 (Cadabam's Pediatric Neurologist): "Knowing when to consult a pediatric neurologist for suspected ADHD comes down to recognizing deviations from typical ADHD or the presence of specific neurological 'red flags' during the initial evaluation. Our goal is diagnostic clarity and safety."

Our Pediatric Neurologists for ADHD concerns provide essential expertise within Cadabam’s multidisciplinary framework, ensuring that potential underlying neurological factors are thoroughly evaluated and appropriately managed.

Case Examples: The Value of Neurological Consultation for ADHD Concerns

Scenario 1: Unmasking Absence Seizures

Presentation:

An 8-year-old girl, Maya, was referred for ADHD evaluation due to frequent "daydreaming" spells in class, declining grades, and seeming "spaced out." Teachers and parents completed rating scales consistent with ADHD-Inattentive type.

Neurological Consultation:

During the pediatric neurological evaluation for ADHD?, the neurologist elicited a specific description of the staring spells – abrupt onset/offset, lasting seconds, associated with unresponsiveness and sometimes subtle eye fluttering. Based on this high suspicion for absence seizures (a condition mimicking ADHD), an EEG was ordered.

Outcome:

The EEG confirmed the diagnosis of Childhood Absence Epilepsy. Maya was treated with an appropriate anti-seizure medication by the neurologist. Her "staring spells" resolved, and her school performance improved dramatically without needing ADHD medication. This highlights the crucial role of pediatric neurologist in ruling out conditions mimicking ADHD.

Scenario 2: Co-Managing ADHD and Tourette Syndrome

Presentation:

David, age 10, had diagnosed ADHD and significant motor and vocal tics consistent with Tourette Syndrome. His ADHD symptoms were impairing schoolwork, but previous trials of stimulant medication had seemed to worsen his tics, leading to discontinuation.

Neurological Consultation:

The Pediatric neurologist for ADHD with co-existing neurological disorders evaluated David. They discussed medication options, including potentially trying a different class of stimulant carefully or using non-stimulant ADHD medications less likely to exacerbate tics (like guanfacine or clonidine, which can treat both). They worked collaboratively with David's psychiatrist.

Outcome:

A careful trial of a non-stimulant medication was initiated under the joint guidance of the neurologist and psychiatrist. This provided moderate improvement in ADHD symptoms without significantly worsening tics. Ongoing monitoring by both specialists allowed for fine-tuning the approach, improving David's overall function.

Scenario 3: Reassurance and Clarification

Presentation:

Parents of 6-year-old Sam were concerned about his hyperactivity, impulsivity, and occasional odd hand movements, worrying about a serious underlying condition. They wondered when to consult a pediatric neurologist for suspected ADHD.

Neurological Consultation:

The neurologist conducted a thorough history and meticulous neurological examination. The exam was entirely normal. The hand movements were identified as likely benign stereotypies common in young children, sometimes seen with ADHD, but not indicative of epilepsy or another progressive disorder.

Outcome:

The neurological evaluation provided crucial reassurance to the parents. Finding no underlying neurological disorder, the neurologist confidently referred the family back to the child psychiatrist and psychologist to focus on standard evidence-based ADHD diagnosis and management strategies, knowing serious mimics had been excluded.

These cases demonstrate the vital role of Pediatric Neurologists for ADHD evaluation in achieving diagnostic accuracy, managing complex comorbidities safely, and providing reassurance when neurological concerns arise alongside attention and behaviour issues.