ADHD & School Problems Flashcards
Name 3 treatments for behavior problems in kids?
1) Parent training programs or parent management training
2) Functional family therapy
3) Multisystemic therapy (school, home, community)
16 year old with ADHD having trouble with sleeping. Goes to bed at 11pm but cannot fall asleep util 1 am. Has a hard time waking up at 7am on school days. Wakes up at 10am on weekends. What is the name of the condition. List 3 strategies
Delayed sleep wake phase disorder
- consistent bed and wake time
- gradual earlier bedtimes
- sleep hygiene
- melatonin
- avoid caffeine
- light therapy in the morning
Indications for treatment of ADHD
- poor school performance
- social or beahvior imapirment
Name 2 numeracy skills before Grade 1 ?
Rote counting till 10 / ordinality
awarness of size difference / comparing objects on length, weight, or volume / generalizability
ability to count objects /one-to -one correspondance
Ordering and sorting
Cardinal principle (recognizing property and numbers wthout having to count)
Co-morbidities with ADHD?
OCD
Sleep disorder
Anxiety
Depression
ASD
Tics
eating disorders
subtance use disorders
DCD
LCD
ratings scales for ADHD
SNAP
Conners
Vanderbilt
What developmental outcomes would you be concerned about in an infant with asymptomatic CMV?
Language delay (2’ to hearing impairment)
Some effect on social development
6 reasons for ineffective stimulant treatment
Non-compliance
Inappropriate dose
anxiety or mood disorder
substance use
SLD
bullying
puberty
sleep disorders
4yo ex-prem with problems at school. Name 4 treatments or consequences of treatments that he received in the NICU that would explain his school difficulties.
Four neuroanatomical parts of the brain affected by ADHD
Cerebellum
prefrontal cortex
anterior cingulate cortex
basal ganglia
4 risk factors for school failure or failure to meet academic expectations
Literacy skills to acheive before grade 1
3 components of reading assessment?
Fluency
word identification (phonenic awareness, visual memory/naming speed)
comprehension ( working memory and influence)
3 characteristic that predict succes for a child starting school
self regulation
social-emotional readiness
physical health and motor readiness
language and communication readiness
cognitive readiness
association between stimulants and height in children
slight reduction in adult growth potential (2.5 cm) and growth velocity over long - term use
name 6 factors to review in ex prem LBW prior to starting school
other than inattentive and hyperactivity symptoms of ADHD, name 6 other criteria
Functionally impairing
2 settings
not associated with other diagnosis
excessive for developmental age
>6 months
onset before 12
name 4 conditions that can mimic ADHD?
Sleep disorders, anxiety disorder, hearing impairment, epilepsy, medication/drug use, head trauma, thyroid dysfunction, SLD, GDD,
Frequency of comorbid diagnosis in ADHD
most common?
50% (CPS)
SLD – 33%
Anxiety – 30%
ASD – up to 50% have traits
Tic disorder
DCD
ODD/CD – up to 90%
Ref: CPS ADHD Pt 1 and 3
SLD (most common) on CPS
Name 5 normal sexual behaviors in children 2 - 6
no pathopneumonic for sexual behavior problems
What are 3 steps in the care of a preschool child who has normal hearing and has been diagnosed with an expressive language disorder?
-speech and language therapy
-parent education and strategies
-high quality childcare/preschool
What are 4 tips for parents who have a preschool child with a diagnosis of receptive language disorder (no deafness)?
-face to face talking
-simple language
-break down instructions into individual steps
-label what interests your child
Causes of acquired hearing loss in kids? (passed initial hearing screen)
-CMV
-ototoxic meds
-meningitis
-trauma
- hyperbilirubinemia requiring transfusion
4 effects of a visual disorder on development
- delayed language acquisition
- delayed motor milestones, specifically walking, decreased exploration of surroundings
- delayed social milestones due to delayed picking up of social skills and non-verbal cues
-delayed cognitive milestones- concept of permanence, etc.
5 features of corticol visual impairment?
1) Preference for colours (vibrant or highly saturated colour)
2) Visual attraction to movement (toys that move)
3) Visual latency (slow or delayed gaze) - Brief fixations, intermittent following
4) Certain visual field preferences - Visual field loss
5) Difficulty with visual complexity - Poor visual acuity
6) Abnormal light response — light gazing or photophobia.
7) Difficulty with distance viewing
8) Atypical visual reflex responses
9) Blunted or avoidant social gaze.
10) hemianopia
weak verbal IQ, 4 problems they may have in school?
· Inaccurate, slow and effortful reading
· Difficulty understanding the meaning of what is read
· Difficulties with spelling
· Difficulties with written expression
5 behavior strategies parents can implement at home to treat ADHD?
-good diet
-good sleep
-structure and routine
-exercise
-parent behaviour training
4 risk factors for school failure/failure to meet academic expectations
younger age
developmental delay
medical illness
lower SES
4 pre literacy skills
- rhyming
- naming and printing letters
- listening and discussing stories
- letter-sound correspondance
- recognizing high frequency words in print
4 pre numeracy skills
one-to-one correspondance of numbers up to 10
matching numbers
comparing objects (size, weight, etc)
organizing and sorting
3 components of reading
phonetic awareness
fluency
vocabulary
comprehension
4 treatments for DCD to improve hand writing
- proper hand position
- wider grip
- more time for assignments
- proper seating
(alternative options: voice to text, typing)
Explain the process and scoring for Goodenough Draw a Person Test
~10 minutes to draw a person
- each body part generally equals a point (count proportions, accuracy, joints, clothing)
4 points = 4 years old
Every 4 points after = 1 more year old
(8 points = 5 yo, 12 points = 6 year old, etc.)
3 primary components of the ABAS needed to assess adaptive functioning
Conceptual
Social
Practical
3 primary components of the Vineland III needed to assess adaptive functioning
daily living, communication, socialization
Ddx for developmental dysfluency and 3 features
Childhood onset dysfluency disorder
- portions of words (rather than repeating full words)
- persistent >5 years old
- causes distres
- facial grimacing
4 areas of the brain affected in ADHD
Asymmetry of the caudate nucleus
· Smaller cerebral and cerebellar volumes
· Smaller posterior corpus callosum
· Smaller pre-frontal cortex
· Frontostriatal network (lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate nucleus, putamen)
· fMRI reduced activation in basal ganglia and anterior frontal lobe
School age child with what sounds likes selective mutism. Two standardized tests of language in this age group (2 ways to test receptive language in a child in the classroom)
Oral and Written Language Scales- 2nd Edition (OWLS-2)
Peabody Picture Vocabulary Test-III
Clinical Evaluation of Language Fundamentals (CELF-5)
ADHD 4 comorbidities that are more common than 10%
learning disabilities, oppositional defiant disorder, conduct disorder, asd, tic disorder, anxiety
4 speech skills a child should have entering school
Speaking 100% intelligibly
Communication in complex grammatically correct and syntax correct sentences
engaging in appropriately reciprocal conversation
Understanding multi-part directions
Defining words by use
Retelling an experience in sequence
DSM criteria for SLD
- difficulties in a particular domain or skill that have persisted for six months despite the provision of interventions;
- academic skills that are substantially and quantifiably below those expected for chronologic age;
- impairment that interferes with academic performance or activities of daily living;
- and onset during the school-age years.
The academic difficulties are not better accounted for by other conditions (eg, intellectual disability, visual impairment, hearing impairment, inadequate instruction, etc).
specified according to the type of academic domains (eg, reading, written expression, mathematics) or specific skills (eg, word reading accuracy, spelling, number sense, etc) that are impaired, as well as their severity
6 things to rule out to make a diagnosis of SLD?
IDD, visual impairment, hearing impairment, inadequate instruction, english second language, secondary to neurological dx (stroke, TBI)
Diagnostic criteria for DCD?
3 things to check on MSK exam and 3 on neuro exam for DCD diagnosis?
5 ddxs for DCD
Steps in treatment of DCD
1 - education (diagnosis and demystifying the condition)
- resources on CanChild
2 - identify and address co-occurring diagnosis (ADHD, SLD)
3 - monitoring of secondary consequences of the disorder (sedentary behavior, overweight/obesity, self-esteem, mental health)
4 - OT or PT for goal of participation in school, home, community
- task specific interventions»_space; sensory based intervention
- COOP
5 - engagement in sports (non-competitive, individual)
4 interventions in DCD to improve written work
Provide extra time for fine motor tasks
Introduce computers as early as possible
Teach specific handwriting strategies (e.g., pencil grips)
Use paper that matches the child’s handwriting difficulties
Specific OT intervention for DCD?
Cognitive Orientation to Occupational Performance (CO-OP)
CMAJ 2015 4 strategies in treatment of DCD?
PT
OT
Task-oriented interventions
Methylphenidate
Dietary supplement with fatty acids
4 comorbidities of DCD
ADHD
ASD
SLD
Language impairment
Two assessment test for motor coordination (DCD)?
Motor ABC-2 (Assessment Battery for Children)
Bruininks-Oseretsky Test of Motor Proficiency -2 (BOT-2)
Beery VMI
6 characteristics of a non-verbal learning disability (not in DSM5)
deficits in left sided tactile perception
deficits in visual-spatial organization
deficits in non-verbal problem solving
relative weakness in arithmetic
deficits in adapting to novel & complex situations
poor social skills
increased internalizing emotional disorders
Prevalence of SLD? which type is most common?
5-15% of population
80% are in reading (dyslexia)
Child with school disorder. Difference of more than 20 points between verbal IQ (weak) and perceptual IQ (strong). He is in 4th grade. What difficulties do you think he will present (4)? (2016)
Linguistic learning difficulties:
Inaccurate, slow and effortful reading
Difficulty understanding the meaning of what is read
Difficulties with spelling
Difficulties with written expression
3 components of SLD in reading
word reading accuracy
reading rate or fluency
reading comprehension
3 components of SLD in written expression
spelling accuracy
grammar and punctuation accuracy
clarity or organization of written expression
4 components of SLD in mathematics
number sense
memorization of arithmetic facts
accurate or fluent calculation
accurate math reasoning
How is severity defined in SLD?
Based on the level of accommodation/support required
Mild - moderate - severe
In-utero risk factors for SLD?
In utero:
air pollution
nicotine exposure
lead exposure
torch infection
manganese exposure
maternal disease
Poor maternal nutrition
Newborn:
low birthweight
preterm
HIE
Hypoglycemia
Endocrine/metabolic disorder
encephalits/meningitis
first degree relative (4-10x higher) or ADHD
NF1 diagnosis (75% have SLD), or other genetic
2 clinical complications associated with DCD?
Obesity, overweight (sedentary behavior)
Low self-esteem (mental health)
3 behaviors that may suggest SLD in a classroom/school setting - preschool? school aged child? adolescent?
Preschool:
Unable to recognize or write letters
Unable to print their name
Trouble recognizing rhyming words
Difficulty learning numbers
Needing concepts to be re-taught
Child:
Not wanting to go to school
Not paying attention in class
Emotional outbursts
Lack of motivation
Adolescent:
Avoiding completing schoolwork
Skipping/missing classes
Anxiety surrounding school and tests/assignments
Negative self-esteem
Difficulty with parents/caregivers
Self-medicating / substances
Low grades / falling behind
Prognosis of SLDs? How do you counsel
Need to specify severity to have better idea of outcome
Lifelong disorder, course and clinical expression are variable based on severity, environment, and supports available
Learning disability has nothing to do with overall IQ
5 consequences of SLD in adolescence and adults?
Higher rates of high school drop out
Lower rates of post-secondary education
Poorer mental health
High rates of underemployment or unemployment
Lower incomes
Best time to complete psycho-ed (or repeat)
prior to transition to adult services
Broad area of intervention in SLD? name 5
Instructional interventions (e.g., small group/ 1:1 instructions)
Training in social cognition
Counseling (e.g., counseling for co-morbid anxiety)
Medication (e.g., ADHD medication)
Accomodations
Collaboration with allied health (e.g., psychologists, SLP, OT, etc)
3 specific strategies that help with SLD in reading ?
peer- assisted learning strategies
RAVE-O (Reading through Automaticity, Vocabulary, Engagement, and Orthograph)
PHAST ( Phonological and Strategy Training)
Comorbidities associated with tic disorders
ADHD
ASD
SLD
OCD
Non-pharmacological treatments of tics?
Habit reversal therapy
Exposure response prevention
2 specific interventions for receptive language delay
Shared Picture Book Reading Interventions
Home-visiting interventions
5 clinical features of language disorder?
4 criteria to be met
difficulty with
- vocabulary
- grammer
- understanding language
- forming sentences
- conversation
persistent difficulties
below expectations language abiities
onset during early development
not attributed to another condition (IDD/GDD)
2 indications for treatment of ADHD?
Learning or academic performance are impaired by attention difficulties (despite psychoeducation and use of behavioural management)
Behaviours and social interactions are impared by lack of impulse control and hyperactivity (despite psychoeducation and use of behavioural management)
name the inattentive criteria for ADHD
> or = 6 (or 5 if >17 yo)
decreased:
- attention to detail
- sustained attention
- listening
- following through on instructions
- organization
dislike or avoidance of challenges/high mental effort
loses things
distracted
forgetful
name the none inattentive/hyperactive /impulsive criteria for ADHD diagnosis
> 6 months
2 or more settings
impacts function (academic and social)
onset <12 years old
not exclusively during psychosis
not secondary to other NDD, medical diagnosis or medication
excessive for developmental age
name the hyperactivity impulsivity symptoms of adhd
> = 6 (or 5 if >17yo)
fidgets
leaves seat
runs/climbs at inappropriate times
cannot play quietly
on the go
talks excessively
blurts answers
difficulty waiting for turn
interrupts or intrudes others
name the 3 specifiers for ADHD
severity (mild - moderate - severe)
type (inattentive - hyperactive/impulsive - combined)
in remission
Name 5 non-pharmacology treatments for ADHD
lifestyle (diet, exercise, sleep, routine)
parent behavior training
social skills training
cognitive skills training
organization skills training
classroom accommodations
3 common comorbidities with ADHD and associated responses to stimulants
Prematurity - increased anxiety
(5x risk of inattentive, 2x risk combined type)
ASD - increase risk of increasing stereotypies, agitation and psychosis
IDD - increase risk of social withdrawal and tics
(improved response if IQ > 50)
Child drops the last consonant of words. What is the name of this speech disorder
speech sound disorder
- Persistent difficulty w/ speech sound production that interferes w/ speech intelligibility or prevents verbal communication or messages
- This disturbance causes limitations in effective communication necessary for social participation, academic achievement or occupational performance (1 or more)
- Onset in early developmental period
Not due to congenital or acquired conditions like CP, CLP, deafness/HI
