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Neuro-Psych Exam II > (Childhood Psych) Neurodevelopment Disorders I-II > Flashcards

(Childhood Psych) Neurodevelopment Disorders I-II Flashcards

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1
Q

3 Diagnostic criteria for Intellectual disability:
In which gender is it more common and why?
Which classification is most common?

A
  1. Subnormal intellectual fxn. globally
  2. Cannot do ADL’s
  3. onset during DEVELOPMENTAL period
    - M> F (fragile X)
    - Most are classified as “mild”
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2
Q

In which SES are mild intellectual disabilities more common? Severe?

A

lower SES; severe ID is evenly distributed

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3
Q

What is a borderline IQ score

A

70-79

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4
Q

Is Intellectual Disability a disease?

A

no, it is a syndrome–this is the end game for a number of diseases that may be genetic or environmentally based
*more severe cases are more likely to have an identifiable cause

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5
Q 
Down Syndrome: 
Cause 
Overall personality 
Clinical manifestations of disease (1) 
At Risk for what Medical Coniditions? (2)
A

Trisomy 21

  • Happy disposition
  • moderate-severe intellectual disability
  • At risk for dementias/ CVD
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6
Q

Prader-Willi:
Cause
Overall personality
Clinical manifestations of disease (3)

A 
Small deletion chrom. 15
Oppositional/ Defiant disposition 
1. intellectual disability 
2. constant hunger/ obesity
3.hypogonadism
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7
Q

Most common inherited form of intellectual disability?

A

Fragile X

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8
Q

Fragile X:

(4) Clinical manifestations/ Common comorbidities

A
  1. men > women
  2. mild to severe intellectual impairment
  3. ^ ADHD, autism
  4. neuro disturbance (stutter, etc.)
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9
Q

PKU:
Cause
Degree of intellectual disability?

A

Loss of phenylalanine hydroxylase

-Intellectual disability, but can be controlled with diet

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10
Q

most common preventable prenatal cause of intellectual impairment? how does this present?

A

fetal alcohol syndrome

presents similar to ADHD –> severe intellectual disability

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11
Q

IQ score for mild disability

Level of arrested development; describe condition

A

55-69
Kiddo stuck in 6th grade (~12yrs old)
Can’t do scientific method, formal operational thought, freak out when the bus doesn’t come that they take every day

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12
Q

IQ score for moderate disability

Level of arrested development; describe condition

A

35-50
kiddo stuck in 2nd grade (7-8yo level)
Generally functional in structured and supervised setting; limited language sills; need reminding to brush teeth, etc.

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13
Q

IQ score for severe disability

Level of arrested development; describe condition

A

20-35
kiddo stuck in preschool (2-3yo level)
Little to no language; restricted mobility; may need hospital equipment and skilled nursing care at home

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14
Q

Important hx question to ask when diagnosing intellectual disability?
What will these kids respond super well to?

A
  • How old are their friends?

- Tangible rewards like stickers

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15
Q

Intermittent Explosive Disorder: define, in which degree of impairment is this found?

A
  • tantrums and meltdowns

- common in mild intellectual disorder

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16
Q

“Autistic Behaviors” most common in which degree of intellectual impairment?
Examples?

A
  • moderate to severe

- self stimulating motor actions, obsessive interest in specific topics

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17
Q

Autism Spectrum disorder (ASD) scale

A

I (formerly aspergers) - III

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18
Q

3 diagnostic criteria for ASD

A
  1. impairment in reciprocal social interaction
  2. impairment in communication and imaginative activity
  3. restricted range of activities and interests
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19
Q

4 common social impairments of ASD

A
  1. lack social response
  2. lack eye contact
  3. lack interest in and response to affection
  4. lack response to emotion in others
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20
Q

Describe the progression of language development in patients with ASD; some features of their language habits (3)

A

Benign development–> drop off around age 2; may be mute

  1. Echolalia
  2. robotic/ abnormal intonation
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21
Q

2 important restricted activities and interests in patients with ASD (dietary? motor)

A
  1. limited food tolerance (sour cream and doritos?)

2. stereotyped motor behaviors (flapping, playing with hands/ fingers to self stimulate)

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22
Q

2 important sensory impairments of patients with ASD

A
  1. tactile defensiveness (don’t like jeans, etc.)

2. super hearing (the ice cream truck)

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23
Q

When are kids screened for ASD? One factor that puts kid at higher risk for ASD

A

18 mos

^ risk if have sibling with ASD

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24
Q

Typical IQ for patient with ASD

A

In general score below avg. but may be very intelligent

*Score effed up sometimes bc test is standardized & patient cannot communicate

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25
Q

Define sevantism

A

Below avg IQ + can perform singular task exceptionally well (Rainman)

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26
Q

Level 1 ASD
Typical IQ
Features of disease

A

Average to > Average IQ

Awkward socially, difficulty with organization and switching between activities

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27
Q

Level 2 ASD

Features of disease

A

more severe than type 1

*marked by ^^^er propensity for distress/ meltdown when required to change or redirect focus/attention

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28
Q

Level 3 ASD

Features of disease

A

Most severe language, flexibility, deficits, etc.

  • Little to no functional verbal output
  • My level 3 kid at daycare: no talking, ran around grunting, stripped his clothes, threw things, tore things, smeared poop on walls, crazy. Nothing normal about level 3.
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29
Q

Accessory impairments to identify with ASD diagnosis

A

ASD +/- intellectual or language impairment

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30
Q

Rhett Disorder**

Describe course of disease

A

normal development up to 5 mos. –> deceleration of head growth 5-48 mos. –> impairment in social/language/motor function
*characterized by hand wringing

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31
Q

Treatment goals of ASD (3)–how is this achieved?

A
  1. Treat psych comorbidities with meds and therapy
  2. promote leaning and problem solving
  3. encourage normal development (social, cognition, etc.)
    * Works best with interdisciplinary team
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32
Q

ADHD diagnostic criteria

A

*problems must span multiple environments (home + school)

ID: mild/moderate/severe

33
Q

Three presentations of ADHS

A
  1. Hyperactive»»
  2. Inattentive»»
  3. combined presentation
34
Q

Which presentation of ADHD gets the most referrals

A

hyperactive; due to disruption

35
Q

Symptoms of inattention (6)

A
  1. poor attention to detail/ common careless mistakes
  2. poor attention during/ ability to organize tasks/ activities
  3. does not seem to listen when spoken to
  4. avoids dislikes+ activities that require sustained attention
  5. loses/ forgets things
  6. easily distracted by external stimuli
36
Q

Which gender is more likely to have ADHD

A

M 3x > F

note that the inattentive subtype is more common in females and diagnosed later

37
Q

Describe 2 neuropath features associated with ADHD

A
  1. Decreased perfusion and metabolism in frontal lobes

2. Altered dopamine receptors

38
Q

first symptoms to remit in patients with ADHD; when does this typically occur

A

hyperactivity; typically occurs between 12-20 yo

39
Q

How to manage ADHD (3):

A
  1. parental education and support
  2. create structured classroom/ learning environment (IEP, Section 504)
  3. Bx therapy or CBT
40
Q

Define specific learning disorder (learning disability)

3 Categories?

A

Patient with NORMAL TO ABOVE AVG IQ*** performs at least two standard deviations below the mean academically

  • reading/math/writing
  • Specify mild/ moderate/ severe
41
Q

Who gets learning disorders more, boys or girls?

What is one predictor?

A

M>F

Familial link

42
Q

What must you exclude when diagnosing a learning disorder (4)

A
  1. neurological/ sensory/ motor causative issue
  2. intellectual deficit***
  3. lack of educational opportunity/ experience
  4. failure to respond to efforts to remediate
43
Q

Common comorbidities with learning disorders; what is one important problem with these patients?

A

mood/ bx./ ADHD disorders

^^^ Dropout rate

44
Q

motor tics: simple vs. complex examples

A 
simple= jerks
complex=  skipping, squatting, smelling or touching others; appear intentional
45
Q

vocal tics: simple vs. complex examples

A 
simple= grunt, snort, snif, bark, squeal 
complex= words and phrases
46
Q

Define a tic

A

involuntary, sudden, recurrent, non-rhythmic stereotyped motor or social bx. –urge for patient to do is compared to urge to sneeze

47
Q

Two common comorbidities with tourettes disorder***

A
  1. ADHD

2. OCD

48
Q

How does Tourette’s disorder differ from Persistent (Chronic) motor/vocal Tic Disorder?

A

Tourettes has BOTH motor and vocal; PCMVTD has one OR the other

49
Q

In which sex is Tourettes disorder more common?

What is the mean age of onset?

A

M>F

Mean age of onset = 7yo

50
Q

1 drug for treating Tourettes?

A

Tenex

51
Q

When treating tourettes, what is meant by treating the hierarchy of sx?

A

Patients may be comfortable with tics but not comorbidities like ADHD or OCD–we would treat the comorbidities sometimes at the expense of treating the tics

52
Q

Define Social Communication Disorder

A

Patients have difficulty with social verbal and nonverbal communication but are not on AS.

53
Q

A communication disorder may be an early sign of what?

What type of problems might these kids have secondarily to the communication issues?

A

Learning disorder; may have secondary bx. problems

54
Q

What is PICA and how does it present?

What type of patients does it typically effect?

A

Patients eat non-food objects for at least 1 mos
Generally patients of lower IQ
*Presents with GI complaints

55
Q

Describe Rumination Disorder:
Typical patient hx?
How is it treated?

A

Repeated regurgitation of food for at least 1 mos (not asstd. with body image issues)
Hx of early neglect, stressful life situations, parental issues
Tx: speech/language pathologist specializes in feeding issues

56
Q

Conduct disorder:
What type of behavior problems do these patients have?
What are their relationships with others like?
What disease might this precipitate into?

A

Conduct = Crime

  • Aggression/ destruction of property / theft/ serious rule violations
  • Shallow relationships and attachments to others
  • Possible precursor to antisocial personality disorder
57
Q

Which sex is more likely to have conduct disorder?

Age of onset?

A

M > F

Childhood onset 10yo

58
Q

5 common comorbidities with conduct disorder:

A
  1. poor academic performance
  2. substance abuse (early onset)
  3. Legal problems
  4. Learning disorders
  5. ADHD
59
Q

Oppositional defiant disorder (ODD): how does it differ from conduct disorder?

A

Patients do not do criminal acts, but are argumentative, defiant, and vindictive for 6+ mos
(example = older sibling popping little sisters bday balloons)

60
Q

3 Typical findings in hx of patient with oppositional defiant disorder

A
  1. does not understand limits/ transitions (tantrum in store if do not get what they want)
  2. Blame others for mistakes/ bx.
  3. no friends
61
Q

How do we treat ODD? What two drugs might we use?

A

^ parenting skills, bx therapy for child

ADHD meds + mood stabilizers

62
Q

Enuresis: definition + which is most common?

When is enuresis diagnosed?

A

Urination in time and place when inappropriate:
nocturnal > dinural (may present with both)
*NOT diagnosed before 5 yo

63
Q

Bx treatment for nocturnal enuresis (2)

What is the thought behind these treatments?

A

Thought that patients sleep too soundly and do not wake up to stimulus for urination

  1. Bell and pad (pavlovian-classical)
  2. Ultrasonic Bladder Alarm
64
Q

Encopresis: definition

When is it diagnosed?

A

Intentional > involuntary deification in time and place when inappropriate
*NOT diagnosed before 4 yo

65
Q

How common is encopresis and with what is it typically associated?
What might you be concerned about if it is involuntary?

A
  • Rare + asstd. with bx. disorders/ mental retardation

- If involuntary think sexual abuse

66
Q

Define Separation Anxiety

A

Excessive anxiety (panic attack) in response to separation from major attachment figure or familiar surroundings

Syndrome is unduly persistent / inconsistent with age (may present in 12 yo)

67
Q

3 potential causative factors asstd. with separation anxiety?

A
  1. fear provoking experience
  2. phobic/ anxious parents
  3. genetics
68
Q

How do we treat separation anxiety therapeutically and pharmacologically?

A

Bx therapy for anxiety management

SSRI + short term BDZ while taking effect

69
Q

What is selective mutism

A

Severe anxiety disorder in which patients do not speak in specific situations (typically outside the home), but will speak normally otherwise

70
Q

How do we manage selective mutism?

A

Psychotherapy in which patients are prompted with questions to which they must provide answer + anxiety meds
*Difficult disorder to treat

71
Q

Disinhibited Social Engagement Disorder:
Cause
Features

A
  • Cause = extremely insufficient care
  • Child will actively approach and interact with adults in sometimes provocative manner; impulsive and disinhibited
  • See in River Park kids with hx of sexual abuse
72
Q

Reactive Attachment Disorder:
Cause
Features

A

Cause = extremely insufficient care

Child is inhibited, socially withdrawn towards adult and caregivers + persistant social and emotional disturbance

73
Q

Disinhibited Social Engagement Disorder +

Reactive Attachment Disorder: prognosis?

A

poor; very difficult to treat

74
Q

Childhood Onset Dysfluency Disorder:

Fancy word for what?

A

Stuttering

75
Q

“Triad” Disorder?

A

Tourettes
ADHD
OCD

76
Q

How to treat dangerous tics that do not respond to tenex?

A

Haldol/ atypicals

severe ADRs so only used if tics cause self harm or harm to others.

77
Q

“Splinter Function” describes?

A

savantism

78
Q

Common reason parents associate autism with vaccination?

A

often assc with dropoff of speech development at age 2 (many vaccines given between 18-24 mos)

Neuro-Psych Exam II (11 decks)

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