50: Neurodevelopmental Disorders Flashcards
developmental window
specific time in early life when brain is activey shaped by environmental input
critical period vs sensitive period
- critical period: environmental input is required for proper development of a particular brain circuit
- sensitive period: environmental input has the greatest inpact on brain circuitry (looser than critical period)
for all neurodevel disorders but motor, what is a big dx criteria
must be present before child enters grade school
intellectual disability**
have to have functioning deficits in 3 domains: conceptual, social, practical
conceptual domain of an intellectual disability
reasoning, problem solving, planning, abstract thinking, judgement
social domain of an intellecual disability
making same-aged friends, reading social cues, conversation and language, difficulty regulating emotion in social situations, gullible
practical domain of intellecual disability
difficulty with personal care, making good decisions about health and well being
global developmental delay
meet observable dx criteria for intellectual disability disorder but cannot participate in standardized testing (too young, TBI, etc.)
four communication disorders
- language disorder
- speech sound and fluency disorder
- social communication disorder
- Childhood-onset fluency disorder (Stuttering)
language disorder
difficulty with spoken, written, and sign language; reduced vocab and sentences are incomplete, negatively impact functioning
speech sound disorder
difficulty making speech sounds -> limits verbal communication, social participation, etc. not due to other condition or limited opportunity for language acquisition
childhood onset fluency disorder (stuttering)
difficulty with fluency and patterns of speech sound - prolongations, pauses, word substitutions to avoid problematic words
social communication disorder
difficulty with social use of verbal and non-vrbal communication - issues with: sharing info appropriately, speaking differently in different settings/to different people, taking turns in conversation, difficulty understanding references/humor/metaphors
when does social communication disorder typically become apparent
early adolescence
seven features of autism
- deficits in social-emotional reciprocity
- deficits in nonverbal communication
- deficits in developing, maintaining, and understanding relationships
- repetitive motor movements or speech
- insist on sameness, routines, rituals
- highly restricted range of interests
- abnormal reaction to sensory input (hyper or hypo-reactivity)
core neurophysiologic feature in autism***
sensory integration deficits
salience network vs default mode network in autism
- salience network: evaluating salient socio-emotional stimuli + mediates interactions with environment
- default mode network: mediates internally-directed processes, involved in directing attention to internal mental events (Develops faster + larger than salience network in autism)**
stimming
use of highly repetitive behavior such as: finger flapping/ finger rubbing, rolling hems of clothes, walking on toes, spinning, twirling
two things that best differentiate autism from intellectual disability**
restricted interests, repetitive behaviors
two drugs FDA approved to tx irritability/agitation in autism**
risperidone, aripiprazole
ADHD
deficit in the ability to gain, sustain, or shift focus
girls and ADHD
less likely to have the disorder recognized bc less disruptive behavior means less referral for help + more commonly have the inattentive subtype
comorbidities with ADHD, esp one big one
- Big one: Tic disorders
2. others: mood DOs, anxiety, SUD, intermittent explosive disorder
what can bring out tics in pt with ADHD?
stimulant medications
Tourette’s syndrome Triad
Tourettes + ADHD + OCD
executive function deficit
problems with: assessing situations, prioritizing, filtering extraneous info, developing a plan of action, executing a plan to completion
where in the brain is executive function deficit targeted?**
prefrontal cortex
what causes executive function deficit in ADHD**
deficiency in dopamine and norep
how many dx criteria does one need to make the dx of ADHD
6+ Sx (5+ in adults 17+)
three tests for ADHD
- TOVA
- Conners continuous performance test
- vanderbilt
Kids 4-5 with ADHD Tx plan
- behavior management
2. methylphenidate if therapy doesnt work
Kids 6-11 with ADHD Tx plan
- ADHD med + behavior management together
Kids 12-18 with ADHD Tx plan
- ADHD med +/- behavior management
2. get consent from the teen
three types of motor disorders
- developmental coordination disorder
- stereotypic movement disorder
- tic disorders
developmental coordination disorder
problems with motor skills - clumsy, hard to catch objects and use scissors, difficult with writing, riding bike, sports
stereotypic movement disorder
repetitive, compulsive, purposeless motor behavior - hand shaking, body rocking, head banging, self-biting, self-hitting
tic
sudden, rapid, recurrent motor movement or vocalization
Tourette’s vs persistent motor or vocal tic disorder
- Tourettes: both vocal and motor tics
2. Motor or Vocal tic disorder: only motor or only vocal tics
Tourette’s onset must be before which age
18
comorbidities with tourette’s disorder
ADHD, OCD, anxiety, mood disorders, risk of suicide, sleep disorders
how long do tics have to occur to be dxed with motor/vocal tic disorder
1+ year
