Approach to Neurodeveopmental & Attention DOs

Question 1

What are the domains of intellectual disability? (3)

Answer 1

1. Conceptual
2. Social
3. Practical

Question 2

Neurodevelopmental DO’s must develop before ______ and produce impairments in _______, _______, _______ or _______.

Answer 2

Must manifest early in development, before grade school & produce impairments of personal, social, academic or occupational functioning.

Question 3

What are tow diagnostic tools for identifying intellectual disabilities?

Answer 3

1. Denver Developmental Screening Tool (DDST)

2. Wechsler Intelligence Scale for Children 5th Ed. (WISC-V)

Question 4

What is global developmental delay?

Answer 4

A child too young to undergo standardized testing for Intellectual Disability DO but meet the observed criteria. They may have acquired an insult during development (i.e. severe head injury)

Question 5

Subcategories for communication DO? (4)

Answer 5

1. Language DO
2. Speech sound DO
3. Social (pragmatic) communication DO
4. Childhood-onset fluency DO - stuttering

Question 6

What communication DO?: Pt. who has difficulty with interpreting spoken or written words, sign language &/or pictures.

Answer 6

Language DO

*not due to hearing/sensory impairment, motor dysfunction, neurologic condition, or language barrier

Question 7

What communication DO?: Pt. who has difficulty articulating words, vocal tones, connecting words fluently.

Answer 7

Speech Sound DO

*not due to limited language acquisition

Question 8

What communication DO?: Pt. who is not able to convey thoughts and feelings verbally or nonverbally primarily with the social use of language.

Answer 8

Social (Pragmatic) Communication DO

*not due to a dx of autism spectrum DO

Question 9

What communication DO?: Pt. who has difficulty with word fluency and patterns of speech SOUND causing pauses with a word, monosyllabic whole-word repetitions (“I-I-I-I see him”)

Answer 9

Childhood-onset fluency DO (stuttering)

*not due to defect or motor sensor deficit.

Question 10

A 6 yo male presents with his parents because they say he is more difficult in raising than his brother. They explain he is hard to communicate with, seems distant, & it is hard to get him to corporate. Upon talking to the boy, he is fixated on toy in his hands, he refuses to make eye contact and he overreacts to a loud phone alarm. Dx?

Answer 10

Autism Spectrum DO

**difficulty with sensory integration (including emotion)

Question 11

In diagnosing ADHD, do girls or boys more commonly present with an inattentive subtype?

Answer 11

Girls

Usually also less disruptive -> referral bias and difficulty in identifying and treating females with ADHD

Question 12

What clinical triad of comorbidities of ADHD can present in children?

Answer 12

Tourette’s syndrome triad
- symptoms of ADHD + OCD + Tourette syn.

**tics can be exacerbated by ADHD meds (stimulants)

Question 13

In ADHD, what biochemically is dysfunctional within the brain?

Answer 13

Executive function deficit from processing dysfunction within the dorsal anterior midcingulate cortex (daMCC) of the prefrontal cortex.

Primarily due to deficiency of DA and NE

Question 14

What are the two subtypes of ADHD?

Answer 14

1. Inattentive type

2. Hyperactive type

Question 15

Diagnostic tools for ADHD? (2)

Answer 15

• Computerized tests (TOVA & Conners Continuous Performance Test)
• Standardized Checklists (Vanderbilt & Conners)

Question 16

What are the American Academy of Pediatrics (AAP) clinical practice guidelines for preschool-aged children (4-5 years of age)?

Answer 16

1. Behavior therapy as first line tx

2. methylphenidate if BT does not provide sig. improvement

Question 17

What are the American Academy of Pediatrics (AAP) clinical practice guidelines for elementary school-aged children (6-11 years of age)?

Answer 17

1. Prescribe FDA approved meds for ADHD &/or behavior therapy

Question 18

What are the American Academy of Pediatrics (AAP) clinical practice guidelines for adolescents (12-18 years of age)?

Answer 18

1. Prescribe FDA approved meds

Question 19

What are the three types of motor disorders?

Answer 19

1. Developmental coordination DO
2. Stereotypic movement DO
3. Tic DO

Question 20

What motor DO?: Pt who is clumsy, has problems with motor skills, like riding a bike and handwriting, to a point that it interferes in self-care, self-maintenance and interferes in school, leisure and activities.

Answer 20

Developmental coordination DO

** Not attributable to a neurological condition or degenerative DO

Question 21

What motor DO?: Pt who has a compulsive or repetitive urge to move without purpose. Sometimes they shake or wave their hand, rock their body or head bang without reason. It interferes in their social and academic life.

Answer 21

Stereotypic movement DO

Question 22

What motor DO?: Pt who has these sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations.

Answer 22

Tic DO

Question 23

What are the dx criteria for Tourette’s Syn

Answer 23

Multiple motor and phonic tics present either
- many times a day nearly every day
- intermittently throughout a period of more than 1 year
before person is 18

Question 24

What are some comorbidities of Tourette’s Syn.? (7)

Answer 24

• ADHD
• OCD
• Anxiety DO
• Mood DOs and risk of suicide
• Disruptive behaviors
• Learning DOs and poor academic performance
• Sleep DOs

Question 25

Meds for Tourette’s Syn.?

Answer 25

• Antidopaminergic
• Dopamine depleters
• Antipsychotics
• Alpha adrenergic agonists
• Botulinum toxin injections
• Anticonvulsant agents