Table 2 The different levels of TAND

Level 1

Behavioural level

This level includes all observed behaviours. The behavioural level is typically evaluated through direct observation or through a range of rating scale measures.

Aggression, anxiety, depressed mood, overactivity, impulsivity, poor eye contact, repetitive and ritualistic behaviours, sleep problems

Level 2

Psychiatric level

This level is defined by psychiatric diagnostic classification systems such as DSM-5 or ICD-11. At this level, the clinician determines whether behaviours observed at level 1 meet criteria for specific psychiatric disorders.

ADHD, autism, anxiety disorder, depressive disorder

Level 3

Intellectual level

This level measures intellectual ability as defined by standardised IQ-type measures.

Intellectual ability within the normal, mild, moderate, severe or profound range.

Level 4

Academic level

This level refers to specific learning disorders (as defined in DSM-5) associated with scholastic performance.

Reading, writing, spelling, or mathematics disorder.

Level 5

Neuropsychological level

This level examines specific brain-referenced systems through the use of standardised neuropsychological instruments.

Selective, sustained or dual-tasking attention deficits; unilateral neglect; immediate recall memory deficits; spatial working memory deficits; visuo-spatial deficits; executive deficits

Level 6

Psychosocial level

This level explores the psychological and social impact of TSC in terms of self, family and community relationships.

Low self-esteem, low self-efficacy, high family stress, parental relationship difficulties, community stigma and isolation