10/17 Neurodevpt Disorders - Petti Flashcards
differences in assessing child/adolescent (as compared to assessing adult)
-
neurodevpt changes
- cognitive
- emotional
- relative importance of the environment
- need to consider motivation for seeking help (often due to parent/teacher request)
- need to differentiate normally expected behaviors from psychopathology
- ex. we expect to see oppositional/defiant behavior in the “terrible twos” and adolescence → separation/individuation phases in which this is normal
- need for indirect methods of assessment in young children
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
intellectual disability
- low intelligence
- need for special help to cope with life in conceptual, social, practical domains
autism spectrum disorder
- impaired social interactions and communication
- stereotyped interest and behavior from early life
language disorder
- delay using spoken and written language
- notable for small vocabulary, sents grammatically incorrect, trouble understanding sents/words
social (pragmatic) communication disorder
- have adequare vocabulary, ability to create sentences BUT unable to use language practically
- conversations/writing tend to be inapprop
specific learning disorder
- problems with reading, written expression, mathematics beyond expected for age
developmental coordination disorder
- motor coordination slowly developed
stereotyped movement disorder
- repeated rocking, head banging, skin or body orifice picking, or biting that is STEREOTYPED
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
intellectual disability
- low intelligence
- need for special help to cope with life in conceptual, social, practical domains
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
autism spectrum disorder
- impaired social interactions and communication
- stereotyped interest and behavior from early life
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
language disorder
- delay using spoken and written language
- notable for small vocabulary, sents grammatically incorrect, trouble understanding sents/words
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
social (pragmatic) communication disorder
- have adequare vocabulary, ability to create sentences BUT unable to use language practically
- conversations/writing tend to be inapprop
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
specific learning disorder
- problems with reading, written expression, mathematics beyond expected for age
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
developmental coordination disorder
- motor coordination slowly developed
pearls for neurodevpt disorder classification criteria
intellectual disability
ASD
language disorder
social (pragmatic) communication disorder
specific learning disorder
devpt coordination disorder
stereotyped movement disorder
stereotyped movement disorder
- repeated rocking, head banging, skin or body orifice picking, or biting that is STEREOTYPED
pearls for neurodevpt disorder classification criteria
Tourette’s disorder
persistent/chronic motor or vical tic disorder
Tourette’s disorder
- multiple vocal and motor tics throughout day
- duration from onset > 1yr
persistent (chronic) motor or vocal tic disorder
- vocal OR motor tics → not both
- duration from onset > 1yr
provisional tic disorder
- tics lasting < 1yr
pearls for neurodevpt disorder classification criteria
ADHD
attention-deficit/hyperactivity disorder
- inattentive, hyperactive, or impulsive (3 presentations)
pearls for neurodevpt disorder classification criteria
ODD
oppositional defiant disorder
- various forms of persistent negative behaviors
- duration from onset is important
pearls for neurodevpt disorder classification criteria
CD
conduct disorder
- persistent violation of rules/rights of others
- duration from onset is important
pearls for neurodevpt disorder classification criteria
disruptive mood dysregulation disorder
disruptive mood dysregulation disorder
- persistently negative, irritable mood between temper outbursts
pearls for neurodevpt disorder classification criteria
MDD
major depressive disorder
- SIG E CAPS
sleep, interest, guilt/worthless/hopelessness, energy, concentration, appetite, psychomotor, SI/HI
pearls for neurodevpt disorder classification criteria
separation anxiety disorder
- anxious and fearful when separated from parents or home
- does not need to begin before 18
pearls for neurodevpt disorder classification criteria
generalized anxiety disorder
- worry about everything
- feel tense
- feel anxious much of the time
kids need 1/3, adults need 3/3
pearls for neurodevpt disorder classification criteria
social anxiety disorder
- imagine being embarassed when speaking, writing, eating in public
pearls for neurodevpt disorder classification criteria
PTSD
- repeated reliving of severely traumatic event
pearls for neurodevpt disorder classification criteria
pica
- eating non-food material
pearls for neurodevpt disorder classification criteria
encopresis
enuresis
encopresis
- repeated defecation after age 4
enuresis
- repeated voiding urin into clothing/bed after age 5
intellectual disability
aka
intellectual developmental disorder
***exam
onset during devptal period
3 of following criteria reqd:
- deficits in intellectual fx confirmed by BOTH clinical assessment and individualized/standardized intelligence testing
-
inability to meet standards for social responsibility and independent learning
- communication
- social participation
- indep living across environments
*
clinical features of intellectual disability
by severity
more severe:
- early manifestation of delayed fx and clinical sx
- dysmorphic features
- decreased adaptive fx over time
less severe:
- later manifestation of sx
- more normal appearance
- increased ability to adapt
psych sx more common in this pop than in general pop
mild intellectual disability vs genpop
conceptual domain
preschool: no obvious diffs
school-age: difficulties learning academic skills (support needed in 1+ areas)
adults: imparied abstract thinking, executive fx, short term memory, fx use of academic skills
more concrete approach to prob solving
mild intellectual disability vs genpop
social domain
immature social interactions
- difficulty accurately perceiving social cues
- communication/conversation/lang more concrete or immature than expected for age
- difficulty regulating emotion and behavior in age-approp fashion
- poor understanding of risk in social situations
- poor social judgment, high gullibility
mild intellectual disability vs genpop
practical domain
age-approp personal care BUT need some support with complex daily living tasks
- grocery shopping
- transport
- food prep
support typically needed to make health care and legal decisions, to learn to perform a skilled vocation, to raise a family
intellectual disability
IQ and level of fx
(mild vs mod vs severe)
mild: 50-55 → 70
- usually fine academically to 6th grade level
- conform socially by late teens
- can be self-supporting in adulthood with ltd guidance needed (unusual social/economic stressors)
moderate: 35-40 → 50-55
- ceiling is 2nd grade level
- may learn to travel alone in familiar places
severe: 20-25 → 35-40
- relatively non-fx
intellectual disability: etiology
approx 50% organic
- known insults from antenatal period
approx 50% unknown
- most have mild ID, prob with genetic basis yet to be discovered
more than 750 known genetic causes! many have known behavioral pattersn
Prader Willi syndrome
vs
Angelmann’s Syndrome
absence of active paternal gene (15q11.13)
- mild-mod intellectual disability
- hyperphagia → obese
absence of active maternal gene (15q11.13)
- mod-severe intellectual disability with motor delays
Fragile X syndrome
2nd most common intellectual disability due to chromosomal abnormality
- devpt delays, mild-mod ID
- connective tissue dysplasia
- gaze aversion
- macroorchidism
- appear to have large ears
ddx for intellectual disability
- major and minor neurocog disorders
- communication disorders
- specific language/learning disorders
- ASD
intellectual disability
course/independence
course depends on multiple factors
mild: 1/4 may function adequately in society
mod: may live semi-indep with partial support
severe/profound: high levels of support/supervision required
what are the communication disorders (5)
- language disorder
- speed-sound disorder
- childhood-onset fluency disorder (stuttering)
- social (pragmatic) communication disorder
- unspecified communication disorder
all begin during early devptal period
language disorder
persistent problem using written and spoken language lagging behind expectations for given age
- compared to peers…
- reduced vocab
- probs putting sents together
- unable to use lang to express ideas adequately
- abilities quantitatively below expected
- often chronic disability in school/work, social situations
ddx: ASD, sensory impairment, intellectual disability, learning disorder (lots of overlap)
social (pragmatic) communication disorder
persistent difficulties in social use of language
- umable to use comm for social purposes in a manner to approp fit social context
- unable to change comm to match context/needs of listener
- diff following rules for conversation or story telling
- diff understanding what is not explicitly stated
difficulties limit effective comm, social participation, social relationships, academic/occupational achievement
onset is in early devptal period (4-5 yr) but may not be noted until later when demands exceed ability for social comm!
- NOT secondary to poor grammar, ASD, ID, or other medical etiology
recall: pragmatic language video
specific learning disorder
impairment in reading & understanding meaning of what’s read
impairment of written expression (spelling, content)
impairment of mathematics (number sense, number facts, calculation, math reasoning)
standardized tests demonstrate fx markedly below those expected for age
- impairment noted in school records allows diagnosis for over 17yrs old
learning difficulties may not become fully manifest until later grades when demands exceed ability
difficulties are not better explained by ID, sensory deficits, lack of proficiency in lang, inadequate ed instruction
learning disorder: course
- poor outcome without recognition and intervention
- high risk for other psych disorders
- persist through lifetime
- needs of child/teen/adult change with developmental stage
ADHD as a diagnosis
mulitple medical diseases and psych disorders present with ADHD sx
ADHD is a complex genetic disorder resulting from combined effects of several genes and interactions with environment
persistent pattern of INATTENTION (6 or more sx for 6 or more months) and/or HYPERACTIVITY/IMPULSIVENESS (6 or more sx for 6 or more months)
- sx more severe than normally seen for comparable devpt level
- 5 sx in either or both for 17+
sx negatively impact social and academic/occupational activity
ADHD and basal ganglia development
ADHD characterized by
- progressive, atypical contraction of ventral striatal surfaces (localized in reward-processing regions)
- non0progressive, fixed contraction of dorsal striatal surfaces (localized in executive fx and motor planning support regions)
“outgrowing” ADHD
people who carry the 7-repeat allele of DRD4 show differences in regional cortical thinning over time → “outgrow” their ADHD
medical disorders presenting with ADHD sx
sleep apnea (risk factors: obesity and/or snoring)
endocrine (esp thyroid)
- hyperthyroid
- resistance to thyroid hormone + ADHD sx
elevated lead levels
neuro diseases
- seizure disorder
- tumors and unusual syndromes
ADHD course
- deficts persist into adulthood
- lower ed achievement
- problems with social skills
- lower occupational status
risk for developing antisocial personality disorder
comorbidities:
- increased use of substances of abuse
- 4x STDs
- 3x unemployed
- 2x divorced or arrested
- incr risk for motor vehicle accidencts when unmedicated
disruptive mood dysregulation disorder
severe recurrent verbal (rages) and/or behavioral (phys aggression) temper outbursts
- excessive and devpt disprop in intensity/duration to situation
persistently irritable/angry mood between outbursts on most days
duration: over 1 year (with absence of under 3 consecutive months of some sx) in at least two settings
dx: first made between 6-18
- onset before age 10 (history or obs)
- no period of more than 1 day meeting full criteria for mania/hypomania
- not occuring exclusively during MDD episode
depression disorders
**sign of depression in children/teens
- disruptive mood dysregulation disorder
- major depressive disorder
- persistent depressive disorder (dysthymia)
for children/teens,
irritability = depression
persistent depressive disorder
dysthymia
depression (or irritability in children) + 2 sx: CHASES
- concentration loss
- hopelessness
- appetite (wt change)
- sleep affected
- energy loss/fatigue
- self-esteem
never sx-free for more than 2mo at a time
separation anxiety disorder
what is it
etiology
duration
criteria
inapprop or excessive anxiety around separation from parenting figures
etiology: genetic predisposition, often develops after life stress
duration: at least 4 weeks children, > 6mo adults
3+ persistent/excessive criteria for dx:
- worry
- refusal or reluctance to go
- repeated nightmares with separation theme
- physical sx when sep occurs/expected
social anxiety disorder
social phobia
marked fear or anxiety about 1+ social situations in which they may be scrutinized or judged
- concern about being embarassed
- children? anx must occur in peer settings (not just interaction with adults)
