ADHD and ID Flashcards
Three subtypes of ADHD
Predominately inattentive type (ADHD-I)
6 inattentive symptoms and <6 HI symptoms
Predominately hyperactive-impulsive type (ADHD-HI)
6 HI symptoms and <6 I symptoms
Combined type (ADHD-C) 6 or more HI AND 6 or more I
ADHD: Diagnostic Criteria inattention
Inattention for 6+ months that negatively impacts social, academic, vocational activities:
ADHD: Diagnostic Criteria hyperactivity and impulsivity
Hyperactivity and impulsivity for 6+ months that negatively impacts social, academic, vocational activities:
ADHD: Diagnostic Criteria age of onset, area where symptoms happen, comorbid
Age of onset prior to 12
Symptoms present in more than one setting
Not exclusively part of another more serious mental health condition: Schizophrenia Psychosis Personality Disorder Substance Abuse Dissociative Disorder
ADHD: Associated Features
memory, language, motor, social
Mild delays in language, motor, social development
Difficulties with memory and executive functions
ADHD: Associated Features
increased risk with?
Increased risk of TBI, suicide attempt by early adulthood
adhd in preschool
adhd as adult
Course: more common to see hyperactivity in preschool ages; inattention and impulsivity still problematic by adulthood
ADHD: Risk Factors?
Gender: 2-1 ratio males to females
Environmental factors:
very low birth weight
Lead exposure
Teratogenic substances in utero
Genetic and physiological:
Highly heritable
Common in TBI, epilepsy, sleep disorders, etc.
examples of genetic syndromes known to be associated with intellectual disability:
Down syndrome (Trisomy 21) Fragile X syndrome Prader-Willi syndrome Angelman syndrome Williams syndrome Tuberous sclerosis complex
Most common genetic disorder associated with intellectual disability, usually in the mild to moderate range (1 in 800 newborns diagnosed); not typically inherited
Down Syndrome
A.k.a. Trisomy 21 due to genetic etiology
Associated physical features and medical complications
Behavioral challenges common
High rates of co-occurring disorders
Down Syndrome
downs Associated physical features include:
flattened face and nose bridge, prominent upper eyelid fold, upward slanting eyes, small ears, short neck, large tongue, Brushfield spots on irises, small hands and feet, single palmar crease, small pinky fingers curving towards thumb, hypotonia (i.e., low muscle tone), short stature
downs Associated medical problems are possible:
congenital cardiac abnormalities (in about 50%), digestive abnormalities, gastroesophageal reflux, orthopedic abnormalities, hearing loss, airway obstruction (obstructive sleep apnea), vision problems, endocrine problems, higher risk of autoimmune diseases, higher risk of acute leukemia, anemia, skin-related problems
downs Behavioral features may include:
limitations in language and communication skills, limitations in cognition and nonverbal problem-solving skills, impulsive and disruptive behaviors, inattention, stubborn or oppositional behavior, increased anxiety/ruminative thinking, social deficits, chronic sleep problems, regression of skills with increased age
downs Higher rates of co-occurring disorders including
autism spectrum disorder, anxiety disorder, obsessive-compulsive disorder, depression, early onset dementia (usually starting around 50 years of age)
Most common inherited genetic disorder associated with intellectual disability (1 in 4,000 males and 1 in 8,000 females), with males being more severely affected than females with this disorder
Fragile X
FMR1 gene mutation, inherited X-linked dominant pattern
Higher rates of co-occurring disorders including:
autism spectrum disorder, ADHD, anxiety, mood disorders
Fragile X
fragile x Associated physical features include
long and narrow face, prominent jaw and forehead, large ears, very flexible fingers, flat feet, high-arched palate, and enlarged testes in males after puberty
Prader-Willi Syndrome Associated physical/medical features include
early feeding difficulties and failure to thrive, developmental delays, delayed puberty, infertility, short stature, small hands and feet, obesity due to hyperphagia, and distinctive facial features such as narrow forehead, almond-shaped eyes, and triangular mouth
Loss of gene function in region of chromosome 15 (not typically inherited)
Prader-Willi Syndrome
Prader-Willi Syndrome Associated clinical features usually include:
most are in mild to moderate range of ID or have learning disability, insatiable appetite, sleep disturbance, irritability, repetitive skin picking, compulsive behaviors
Genetic cause: Loss of UBE3A gene function (most cases involve a segment deletion on chromosome 15, with other mutations occurring as well); most cases are not inherited
Angelman Syndrome
Angelman Syndrome Associated physical/medical features include:
microcephaly, ataxic movements, “coarse” facial features, epilepsy
Angelman Syndrome
Associated clinical features usually include:
most present with severe to profound ID, absent or limited expressive language, significant developmental delays by 6-12 months of age, frequent smiling or bouts of laughter (happy, excitable demeanor), stereotyped/repetitive mannerisms, sleep difficulties, inattention
