ADD, Autism, Aspergers Flashcards
Major feature of ADD
Paying too much attention to too many things (having little focus rather than too little attention)
Types of ADD
- Attentional
- Hyperactive/impulsive
- Combined
Diagnostic criteria of ADD/ADHD
- Onset is NO later than 7 yo
- Symptoms present in 2 or more situations (school, home)
- Disturbance causes clinically significant distress or impairment in functioning
Diagnostic criteria of inattention/hyperactivity/impulsivity
- 6 or more symptoms
- Symptoms have been present for at least 6 months
- Symptoms are inappropriate for developmental level
Treatment of ADD
- Behavioral psychotherapy with effective medication
- Stimulants (methylphenidate) 1st line: side effects MC anorexia w/wt loss, mood effects, tics
What is the 1st line pharm treatment of ADD? MC side effects?
Stimulants (meythlphenidate, dextroamphetamine)
- Anorexia w/wt loss
- Mood effects
- Tics
Diet changes to treat ADD/ADHD
Ineffective
What is the origin of learning disorders?
Neurologic
What is the central clinical feature of a learning disorder?
Lack of normal developmental skill, either cognitive or linguistic
What does a learning disorder NOT include?
Learning problems caused primarily by:
- Vision, hearing, motor impairments
- Mental retardation
- Emotional disturbance
- Environmental, cultural, economic disadvantages
What is a reading learning disorder?
Dyslexia
What skills are impaired with reading learning disorder?
One or more impairments in the 3 skills necessary for reading:
- Word decoding
- Automaticity of letter and word recognition
- Understanding the meaning of words
What is the deficit of dyslexia?
Language processing - deficient decoding of phonemes (individual linguistic units, smallest detectable sound in a spoken word)
What are phonemes?
- Smallest detectable sound in a spoken word
- Dyslexia is a deficient decoding of these
Define morpheme
Smallest meaningful speech sound
Define grapheme
Smallest unit in written language
What is the major phonetic processing consequence of dyslexia?
Cannot adequately pair the visually processed graphemes with their associated phonemes (reading problems)
Treatment of reading learning disorder
- Referrals to special ed (SLP)
- Treatment of comorbidities
- Consider ophtho
- Ocular training appears to be INEFFECTIVE
Ocular training for dyslexia?
Appears to be ineffective
Describe dysgraphia
- Writing learning disorder
- Uncertain whether this exists as an isolated disorder (usually in combo with reading and other disorders)
What does the process of writing connect?
Writing connects cognition, language, and motor skills
Treatment of math learning disorder
- Address specific subcomponent deficits
- Exploit a child’s developmental strengths and subject area affinities
- Bypass techniques (circumvent the deficient math task component)
- Teach real life math
- Improve curriculum in US
Define autism generally
Persistent deficits in social communication and interaction across multiple contexts
What is severity of autism based on?
Social communication impairments and restricted, repetitive patterns of behavior
How must symptoms present in autism to be diagnostic?
- Must be present in the early developmental period
- BUT may not become fully manifest until social demands exceed limited capacities
- OR may be masked by learned strategies in later life
What may explain some of the increased rates of PDD NOS?
- Screen time has increased
- May reinforce repetitive behaviors in vulnerable children
- Decreases amount of interpersonal interactions
What may explain hyperacoustic hearing in autistic patients?
Central auditory processing deficits that suggest distorted pathways between hearing and cortical processing
Diagnosis of PDD requires that features be present by when?
3 yo
Epidemiology of PDD
- Males 5:1 for PDD/autism
- Males 10:1 for Aspergers
- Increase in reported cases probably due to increased identification of cases
Clinical presentation of PDD
- Language development issues (especially receptive)
- Poor social interaction
- Sensory integration difficulties
- Stereotypic behaviors
What does the AAP recommend for screening of PDD?
M-CHAT (Modified Checklist for Autism in Toddlers)
-Given at 18 and 24 months
What are critical items of the M-CHAT?
- Does your child imitate you?
- Does your child respond to his/her name?
- If you point at a toy, does your child look at it?
- Does your child take interest in other children?
- Does your child use index finger to point?
- Does your child bring objects over to you?
What is Retts syndrome?
- X linked d/o in females (lethal in males)
- Leads to developmental reversals especially in expressive language, hand use, breath holding
What is Fragile X?
MC cause of inherited mental retardation
- Flat feet, flexible joints, low muscle tone
- Large body size, forehead, long face
- Soft skin
- Macroorchidism
What 2 disorders should be ruled out when evaluating for PDD?
Retts syndrome
Fragile X
Neuropsych testing for PDD
- Distinguish PDD NOS from a mood disorder
- Identify verbal and nonverbal learning disabilities
Treatment of PDD
- Antipsychotics
- Treatment of comorbidities (ADHD, OCD, etc.)
Pathophys of autism
Abnormalities of cellular configurations in several regions of the brain
Possible lab findings of autism
- High whole blood serotonin
- Low serum biotinidase
- High C-terminally directed beta-endorphin protein immunoreactivity
- Oxidative stress
- Hyperlacticacidemia
- Mitochondrial disorders
MRI finding of autism
Enlargement of the total brain
Treatment goal of autism
EARLY identification - well meaning attempts not to “label” children can deprive them of specialized services
Pharm treatment of autism
No meds are efficacious for the core symptoms of autism
Antidepressants in treatment of autism?
Help with compulsions/repetitive behaviors
Features of Asperger syndrome
- Persistent impairment in social interactions
- No significant aberrations or delays occur in language (UNLIKE AUTISM)
- Limited capacity for spontaneous social interactions
Major difference between autism and Asperger’s?
In Aspergers, there are no significant aberrations or delays in language
Life expectancy of Aspergers
Normal, except as impacted by comorbidities (especially depression)
Clinical presentation of Aspergers
- Peculiar and narrow interests
- Sensitivity to sound, touch, pain, texture of foods
- Synesthesia (“loud shirt”)
- Interprets language literally (sarcasm is difficult)
Treatment of Aspergers
- Adaptations to sensory abnormalities (sunglasses, earplugs)
- Psychotherapy
- Relaxation training
- Encouragement of special skills
- Meds are for comorbidities
