Chapter 13 in class notes Flashcards
What is the prevalence of adhd
5%
Adhd normally diagnosed?
When is onset?
5-6 years old.
Before she 3-4
Neurodevelopmental disorders
Conditions manifesting early in development.
Adhd Specific learning DO Autism spectrum Intellectual disability Communication & motor DOs
Adhd is ____ more likely to be diagnosed in males vs females why?
2-3x more likely.
Males present differently than females - hyperactive
Cultural factors of ADHD
US diagnoses more than everywhere else. Agricultural based countries - significantly less ADHD.
Subtypes of adhd
1) predominantly inattentive presentation (mostly girls)
2) predominantly hyperactive/impulsive presentation (mostly boys)
3) combined presentation - inattentive and hyperactive (either girls and boys)
Causes of ADHD
- G_
- N_
- N_
- P_
- Genetic
- Neurobiological correlates of ADHD (frontal lobe decrease, temporal lobe-balance impairment, hippocampus - memory of consequence) toxins - smoking increases likelihood
- Neurotransmitters (low levels of dopamine and norepinephrine)
- Psychosocial factors (abuse and neglect, lower education)
neurobiological correlates of ADHD
frontal lobe decrease (executive planning, impulse control)
temporal lobe (balance impairment)
hippocampus (memory of consequence)
toxins (smoking increases likelihood)
what are some neurotransmitter correlates of ADHD?
low levels of dopamine and norepinephrine
What is the role of toxins in ADHD?
toxins increase likelihood of ADHD.
smoking no genetics - 1%
smoking plus genetics - 3%
Psychosocial factors of ADHD
higher risk if:
abuse and neglect
lower education
higher socioeconomic status
What’s the goal of biological treatment of ADHD?
Increase activity in frontal lobe. Stimulant medication
Ritalin
Dexedrine
Adderall - less effective, used if no response w/ ritalin. long time in body
What are secondary sexual characteristics of ADHD?
As a teenager person still looks like a young child. Decreases appetite. Deregulates hormones.
ADHD - cure?
no cure, just treatments.
medication increases insomnia
anxiety due to stimulant
What is ADHD HI subtype?
Hyperactive Impulsive
Specific learning DO disability
A) Needs to endure for ___ months - why?
A) 6+ months to rule out change in home
Subtypes of specific learning disability
A) with impairment in R____
B) with impairment in W___
C) with impairment in m___
A) reading
B) Written expression
C) mathematics (number sense - 8 is less than 9)
Aphasia
can recognize word but can’t say it. Can define it though.
Dysphasia
get part of the word but not the whole
for specific learning disability, what does impairment in reading look like?
- deficit in rate or fluency - rate of reading
- poor reading comprehension
- aphasia (can recognize word but can’t say it) or dysphasia (get part of word but not whole)
for specific learning disability, what does impairment in written expression look like?
- visual motor deficit
- spelling or grammar errors (they could say sentence but when asked to write they mess it up)
- poor clarity
for specific learning disability, what does impairment in mathematics look like?
Difficulty with:
- number sense - 8 is less than 9
- memorization of arithmetic facts - use of calculator a problem - basic addition and subtraction
- accurate or fluent calculation
- accurate math reasoning
What is the prevalence of learning disorders?
about 6 million people
negative school experience - low self esteem, anxiety
Statistics of learning disorders
A) Wealthier vs lower socioeconomic regions
B) reading difficulties - % of population
C) causes and treatment
D) psychosocial contributions
E) requires ____
A) higher rates in wealthier areas - due to more testing
B) 4-10% of population
C) Genetic & neuro biological contribution. Runs in families
D) home environment - parent-child reading. how much screentime. math importance
E) intense educational interventions. remediation early on before compounding of issues.
Autism Spectrum DO
A) Problems occur in ___, ___, and ____
B) Two main areas of impairment: ____ and ____
A) language, socialization and cognition
B) [communication and social interaction] and [restricted, repetitive patterns of behavior, interests, or activities]
Echolalia
communication - echo your words, no purpose
Autism Spectrum: Describe communication and social interaction impairment
- Autism (social interaction deficit impairment)
- Echolalia (communication)
- 25% do not acquire effective speech (can’t communicate well)
Autism Spectrum: Describe restricted, repetitive patterns of behavior, interests or activities
- self-stimulating behaviors: no trigger (rocking, head banging, drop/pick up)
- high consistency in activities (high level of structure. Eat noon. Bed at 7)
ASD includes the following A) A B) A\_\_ C) C_ D) R_ E) I_
A) Autism B) Asperger's C) Childhood disintegrative DO D) Rett syndrome E) Intellectual disabilities
ASD and Asperger’s similarities
- little eye contact
- little response to others as a baby
- rarely initiate sharing of enjoyment
- unusual and sometimes inappropriate response to others’ emotions
ASD differences from Aspergers:
- often low to midrange IQ
- physical development delays
- mental developmental delays
Asperger’s syndrome differences from ASD:
- usually mid to very high range IQ
- rarely have physical developmental delays
- rarely have mental developmental delays
Rett's syndrome A) What is it? B) one in \_\_\_\_ to \_\_\_\_ girls C) loss of \_\_\_ D) shrinking in \_\_\_ E) cognitively \_\_\_\_
A) motor skills deficit primarily in girls
B) 10K to 15K
C) purposeful hand movements, develop of hand movements wringing, clasping hand.
D) behavioral variety - default behavior
E) cognitively NOT compromised
Rett's syndrome A) loss of \_\_\_, \_\_, \_\_\_, B) life expectancy C) They are (aware or not aware) of what's happening to them D) often struggle with \_\_\_\_ disorder
A) speech, balance/coordination, 40% or more lose all ambulatory activity
B) 50-60 years
C) aware
D) anxiety
Childhood disintegrative disorder
A) prevalence
B) live to ___ years old
C) describe what happens
A) 1.7 per 100,000
B) live to 60 years old
C) period of normal development before onset of deterioration and loss of skills
Childhood disintegrative disorder
D) typical age of onset
E) deterioration of ___
F) ____ and ____ skills still intact
D) 3-4 years
E) deterioration in self help and motor skills often marked
F) cognitive and social skills still intact
ASD Biological correlates (not causes) A) Genetic B) parents C) Neurobiological influences - A\_\_\_ larger and \_\_\_ - O\_\_\_ - lower levels than \_\_\_
A) 1 child with ASD = 20% risk for 2nd child. (100x greater than gen population)
B) older parents’ kids. above 50 years old parents (especially women)
C) Amygdala larger and damaged
D) Oxytocin lower levels than average. socially withdrawn. bonding and social memory.
Treatment of ASD
A) ___ ____ is critical
B) Psychosocial treatments - cognitive treatments _____
C) Behavioral approaches
A) early intervention (highest marker for prognosis)
B) are not effective
C) need to do things to learn things. be very specific.
Intellectual disability disorder (IDD) A) Used to be called \_\_\_\_ B) Can be \_\_\_\_ or \_\_\_\_ C) IQ typically below \_\_\_\_ D) What could look like this DO?
A) mental retardation
B) standalone or accompany another (i.e. autism)
C) 70-75
D) Major depression
IDD - difficulties in 3 domains
A) C_
B) S_
C) P_
A) Conceptual - typical IQ. basic knowledge. ability to read, working memory
B) Social - ability to form relationships, understand social cues, social norms
C) Practical - normal daily living activities, money - how to use, purpose. Hygiene. street smarts
IDD prevalence
about 2%
[exam] IDD can be ___ or ___
standalone or accompany another (i.e. autism)
[exam] Intellectual Disability Disorder Mild A) Longevity B) Conceptual Domain C) Social Domain D) Practical Domain
A) 45-65
B) in preschool - no obv differences.
school age: difficulties in learning academic skills needed to meet age related expectations.
Adults: abstract thinking, executive function (planning) and STM as well as functional use of academic skills are impaired.
C) compared with typically developing age-mates, the individual is immature in social interactions. difficulty in perceiving peers’ social cues. there may be difficulties regulating emotion and behavior in age-appropriate fashion
D) individuals need some support with complex daily living tasks in comparison to peers. in adulthood, supports typically involve grocery shopping, transportation, home and child-care organizing, nutritious food preparation, and banking and money management. support is typically needed to raise a family.
[exam] Intellectual Disability Disorder Moderate A) Longevity B) Conceptual Domain C) Social Domain D) Practical Domain
A) 30-45
B) all through development, the individual’s conceptual skills lag markedly behind those of peers. ongoing assistance on a daily basis is needed to complete conceptual tasks of day-to-day life, and others may take over these responsibilities throughout the lifespan
C) friendships with typically developing peers are often affected by communication or social limitations. significant social and communicative support is needed in work settings for success
D) can care for personal needs involving eating, dressing, elimination, and hygiene as an adult, although an extended period of teaching and time is needed for the individual to become independent in these areas, and reminders may be needed.
[exam] Intellectual Disability Disorder Severe A) Longevity B) Conceptual Domain C) Social Domain D) Practical Domain
A) 20-35
B) attainment of concepts is limited (e.g. money, time, quantity). caregivers provide extensive supports for problem solving throughout life
C) spoken language is quite limited in terms of vocab/grammar. single words or phrases, communication are focused on here and now within everyday events.
D) individual requires support for all activities of daily living including meals, dressing, bathing and elimination. requires supervision at all times. cannot make responsible decisions regarding well-being of self or others.
[exam] Intellectual Disability Disorder Profound A) Longevity B) Conceptual Domain C) Social Domain D) Practical Domain
A) not past 6months or 10 years old
B) conceptual skills generally involve the physical world rather than symbolic processes. motor and sensory impairments may prevent functional use of objects even if certain visuospatial skills are intact
C) very limited understanding of speech or gesture. may understand some simple instructions or gestures, expresses desires and emotions largely through nonverbal, nonsymbolic communication.
D) dependent on others for all aspects of daily living. may assist with some daily work tasks at home (i.e. carrying dishes to the table). need high levels of ongoing support
IDD: longevity ___ as IQ ___
decreases, decreases
Causes of IDD
A) Most ___
B) Hundreds of ___ causes
A) unknown. no identified etiology
B) known
Environmental causes of IDD
- early trauma/abuse
- sleep deprivation
- malnutrition
Prenatal causes of IDD
- mom drinking alcohol or smoking or inhaling 2nd hand smoke
- mom falls
- mom is abused (hit, deprived of O2) - any trauma
Perinatal causes of IDD
- during labor 10-15 seconds for damage to brain w/o oxygen
Postnatal causes of IDD
- maternal depression - 5% of moms get severely depressed (suicidal/homicidal). neglect
- less eye contact w/ baby. touch baby less.
- tactile stimulation > brain development
- feed baby less
Anoxia
an absence of oxygen
Genetic Influences for IDD
A) ___ DO
B) multiple ____ ___
A) Chromosomal disorders: vast majority= early death. down’s syndrome - one of few where child lives
B) multiple genetic mutations (vs. single gene) - no single gene.
What kind of genes are responsible for IDD?
Recessive genes. If the gene was dominant the person would likely be infertile.
Phenylketonuria (PKU)
A) Prevalence rate
B) Due to ___
A) 2 of 1,000 cases
B) Phenylalanine (in high protein foods, anything processed)
Down's syndrome A) Most common \_\_\_\_ B) Life expectancy C) also known as \_\_\_\_ D) correlated with \_\_\_ age
A) chromosomal cause of intellectual disability
B) 40-50 years old depending on severity
C) trisomy 21 - extra 21 chromosome
D) maternal age - at age of 45 - spike. 35 not much higher
Physical signs of Down's Syndrome A) Decreased \_\_\_ at birth B) Excess \_\_\_\_ C) Flattened \_\_ D) \_\_\_\_ slanting \_\_\_ E) Small \_\_\_ F) Small \_\_\_, big \_\_\_ G) Wide \_\_\_ H) Separated \_\_\_ I) Single \_\_\_ J) \_\_\_\_ spots \_\_\_
A) Decreased muscle tone at birth (kick back push. higher risk of SIDS)
B) Excess skin at nape of neck (45degree angle)
C) Flattened nose (nostril smaller. oxygen difficulties)
D) Upward slanting eyes
E) Small ears (compromises hearing)
F) Small mouth (big tongue protruding - speech difficult and choking risk)
G) Wide short hands with short fingers (webbing between fingers, not as dextrous/fine motor skills)
H) Separated joints between the bones of the skull 0 more collapsing between spinal cord
I) Single crease in the palm of the hand
J) White spots on the colored part of the eye (optic nerves not functioning in white spots)
Down’s syndrome is detectable with ____
some prenatal tests
Prenatal tests to detect down’s syndrome
A) least invasive
B)
C) most invasive
A) Mother’s blood test. gives POSSIBILITY of Down’s syndrome. Least invasive and least accurate
B) Chorionic villus sampling (CVS) - 99% accurate - needle & pull out tissue. Risk to placenta.
C) Amniocentesis (2nd trimester test - 100% accurate. needle & extracting tissue straight through into utero. Possibility of puncturing baby. Placenta risk too. 1 in 10K miscarriage as compared to 1 in 50K normal w/o tests.)
Prenatal tests to detect down’s syndrome can’t tell you __
how severe
Neurocognitive Disorder Impairment in four categories 1) A 2) L 3) M 4) C
1) affect
2) learning
3) memory
4) consciousness
Onset of Neurocognitive DO is when?
Later adulthood 50s, 60s, 70s
Three classes of neurocognitive disorders:
A) D_
B) D_
C) M__ or M___
A) Delirium (temporary confusion and disorientation)
B) Dementia (long term confusion and disorientation)
C) Major or mild neurocognitive DO (broad cognitive deterioration)
Dementia (a neurocognitive DO)
A) define
A) long term confusion and disorientation. Doesn’t come back.
affects person, place and time. awareness of present moment.
Delirium (a neurocognitive DO)
A) Define
A) temporary confusion and disorientation. Comes back to baseline eventually
Amnestic disorders - not linked to ____
organic cause
DSM perspectives shift - not worried about
why, just symptoms
Delirium - description of impairment
impaired or disturbance in consciousness and cognition (e.g. reduced ability to direct, focus, sustain and shift attention)
OR
impaired awareness of consciousness or cognition (e.g. reduced orientation to the environment)
Delirium A) Develops \_\_\_ B) Appear \_\_\_ C) Marked \_\_\_ and \_\_\_ effects D) Additional disturbance \_\_\_\_
A) rapidly over several hours or days
B) confused, disoriented and inattentive
C) Marked memory and language effects (encoding of recent events deteriorates. Tip of tongue effect happens frequently)
D) Additional disturbance in cognition (e.g. memory deficit, disorientation, language, visuospatial ability, or perception - misunderstanding others emotions)
Delirium
A) Affects up to ___ of adults in acute care facilities
B) More prevalent in certain populations including
C) Full recovery?
D) Dementia
A) Affects up to 20% of adults in acute care facilities
B) Older adults, those undergoing medical procedures, AIDS and cancer patients.
C) Full recovery often occurs within several weeks
D) 50 % of cases involve temporary delirium
Delirium treatment
A) attention to ___
B) Psychosocial interventions
A) precipitating medical problems (what meds are they on?)
B) reassurance/comfort, coping strategies, inclusion of patient in treatment decision.
Risk factors of delirium
Benzodiazepines Underlying diseases (demention) constipation urinary tract infections pneumonia fatigue, sleep deprivation
Delirium vs Demential vs Depression
- whats the biggest difference w/ depression?
MOOD. and suicide
Dementia - describe
- gradual deterioration of brain functioning
- deterioration in judgement and memory (poor decisions)
- deterioration in language/advanced cognitive processes
Dementia has many _____
causes and may be irreversible
Mild Neurocognitive Disorder
A) Easy/hard to diagnose
B) describe
C) Functioning
A) Hard to diagnose
B) Mild/modest cognitive decline from a previous level of performance in one or more cognitive domains.
C) able to function independently with some assistance and reminders
Domains affected by neurocognitive DO (mild and major)
- complex attention
- executive functioning
- learning and memory
- language
- perceptual motor cognition (judging distance)
- social cognition (interpersonal skills, personal space)
Major Neurocognitive Disorder
A) describe
B) substantial ___
A) significant cognitive decline from a previous level of performance in one or more cognitive domains.
B) and broad impairment
Major neurocognitive disorder
A) initial stage
B) later stages
A) memory and visuospatial skills
facial agnosia
B) continued deterioration: daily activities - starts minor and progresses to total support for daily activities. liquid diet. early death (onset of other illness)
Alzheimers disease is diagnosed when?
post mortem. CAUSE not figured out until death.
Alzheimer’s disease accounts for ___% of neurocognitive disorders
50%
Alzheimer's disease A) greater prevalence in \_\_\_ B) education C) men to women D) Prevalence in ethnic groups
A) low-education groups
B) higher education - delayed onset, but more rapid decline (just starts later)
C) women at slightly higher risk due to longevity
D) thought to be low but likely a reflection of education and who seeks care.
Alzheimer’s disease: Clinical features
A) brain
B) mood
C) AAA
A) memory, orientation (person, place, time), judgement (poor reasoning skills) and reasoning deficits
B) agitated, confused, combative (due to confusion/fear)
- depression and/or anxiety
C) Aphasia (loss of ability to understand/express speech), apraxia (motor disorder) and agnosia (failure to recognize objects/faces)
Aphasia
(mnemonic device: “ph” and “s” from aphasia [sp_ _ _h] .
loss of ability to understand or express speech, caused by brain damage.
think sPeecH.
Apraxia
mnemonic device: axia as in axis
motor disorder caused by damage to the brain (specifically the posterior parietal cortex) in which the individual has difficulty with the motor planning to perform tasks or movements when asked, provided that the request or command is understood and the individual is willing to perform the task.
Agnosia
failure to recognize objects/faces
Alzheimer's disease progression A) Onset B) Survive \_\_ years after onset C) Deterioration speed in phases D) at the end deterioration targets \_\_\_
A) usually 60s or 70s
B) 8 years
C) slow during early and later stages. rapid during middle stages
D) lungs, heart, etc.
Alzheimer's disease causes A) multiple \_\_ B) early AD C) later AD D) \_\_\_\_ plaques E) \_\_\_ in brain
A) genes
B) Chromosome 14
C) Chromosome 19
D) amyloid plaques ( grow between neurons. blocks dendrites/connection
E) atrophy in brain (neuronal connections die off. Neurofibrillary tangles - become hardened and tangled, cutting off oxygen supply and killing neurons. Frontal lobe atrophy)
Amyloid plaques
lumps of beta-amyloids, which destroy connections between nerve cells
Atrophy in brain
neuronal connections die off.
Neurofibrillary tangles - become hardened and tangled, cutting off oxygen supply and killing neurons.
Frontal lobe atrophy
neurofibrillary tangles
strand like tangles within the neurons. They normally exist in brain but become hardened and tangled, cutting off oxygen supply. kills off neurons.
Alzheimer’s disease brain atrophy
A) temporal lobe
B) limbic system
C) occipital lobe
A) sensory/meaning memory. forgetting major events
B) aggression, etc.
C) agnosia. visual memory - middle stage
Psychosocial factors/contributions - alzheimers
A) causal lifestyle factors?
B) lifestyle factors affect ___
C) higher risk for certain groups
A) none
B) how early you will get alzheimer’s disease
C) poor social support (more stress). poor education. cognitively sedentary lifestyle (watching tv)
psychosocial treatments - Alzheimer’s
A) enhance __
B) ____ skills
A) enhance lives of patients and caregivers
B) compensatory skills (e.g. lists and schedules)
Medical treatments for neurocognitive
A) most treatments ___
B) Some drugs target ____ ____
A) simply slow the progression of deterioration but cannot stop it.
B) cognitive deficits - long term effects not known. associated with depression and anxiety.
medical treatments for neurocognitive
A) few ___
few treatments (e.g. no cure or treatment for Huntington’s Disease but treatment for Parkinson’s disease)
severity level for ASD:
A) Level 1
B) Level 2
C) Level 3
A) Requiring support
B) Requiring substantial support
C) Requiring very substantial support
Level 1 severity for ASD:
A) social communication
B) Restricted interests and repetitive behaviors
A) without supports in place, deficits in social communication cause noticeable impairments. has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. may appear to have decreased interest in social interactions
B) rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest
Level 2 severity for ASD:
A) social communication
B) Restricted interests and repetitive behaviors
A) marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others
B) RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the causal observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest
Level 3 severity for ASD:
A) social communication
B) Restricted interests and repetitive behaviors
A) Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others
B) preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.
Delirium (vs Dementia vs Depression) A) Onset B) Course C) duration D) consciousness E) attention F) psychomotor changes G) Reversibility
A) Acute (hours to days) B) Fluctuating C) Hours to weeks D) Altered E) Impaired F) Increased or decreased G) Usually
Dementia (vs Delirium vs Depression) A) Onset B) Course C) duration D) consciousness E) attention F) psychomotor changes G) Reversibility
A) Insidious (months to years) B) Progressive C) Months to years D) Usually clear E) Normal except in severe dementia F) Often normal G) Irreversible
Depression (vs Delirium vs Dementia) A) Onset B) Course C) duration D) consciousness E) attention F) psychomotor changes G) Reversibility
A) Acute or Insidious (weeks to months) B) May be chronic C) Months to years D) Clear E) May be decreased F) May be slowed in severe cases G) Usually
Types of Major and Mild Neurocognitive Disorder
- due to Alzheimer’s disease
- frontotemporal degeneration
- vascular disease
- with Lewy bodies
- due to traumatic brain injury
- substance/medication induced
- due to HIV infection
- due to prion disease
- due to Parkinson’s disease
- due to Huntington’s disease
- due to another medical condition
- due to multiple etiologies
- unspecified - dementia
If a family has 1 child with ASD, what’s the risk for the 2nd child?
20% risk for 2nd child. (100x greater than gen population)
