(Childhood Psych) Neurodevelopment Disorders I-II Flashcards
3 Diagnostic criteria for Intellectual disability:
In which gender is it more common and why?
Which classification is most common?
- Subnormal intellectual fxn. globally
- Cannot do ADL’s
- onset during DEVELOPMENTAL period
- M> F (fragile X)
- Most are classified as “mild”
In which SES are mild intellectual disabilities more common? Severe?
lower SES; severe ID is evenly distributed
What is a borderline IQ score
70-79
Is Intellectual Disability a disease?
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
Down Syndrome: Cause Overall personality Clinical manifestations of disease (1) At Risk for what Medical Coniditions? (2)
Trisomy 21
- Happy disposition
- moderate-severe intellectual disability
- At risk for dementias/ CVD
Prader-Willi:
Cause
Overall personality
Clinical manifestations of disease (3)
Small deletion chrom. 15 Oppositional/ Defiant disposition 1. intellectual disability 2. constant hunger/ obesity 3.hypogonadism
Most common inherited form of intellectual disability?
Fragile X
Fragile X:
(4) Clinical manifestations/ Common comorbidities
- men > women
- mild to severe intellectual impairment
- ^ ADHD, autism
- neuro disturbance (stutter, etc.)
PKU:
Cause
Degree of intellectual disability?
Loss of phenylalanine hydroxylase
-Intellectual disability, but can be controlled with diet
most common preventable prenatal cause of intellectual impairment? how does this present?
fetal alcohol syndrome
presents similar to ADHD –> severe intellectual disability
IQ score for mild disability
Level of arrested development; describe condition
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
IQ score for moderate disability
Level of arrested development; describe condition
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.
IQ score for severe disability
Level of arrested development; describe condition
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
Important hx question to ask when diagnosing intellectual disability?
What will these kids respond super well to?
- How old are their friends?
- Tangible rewards like stickers
Intermittent Explosive Disorder: define, in which degree of impairment is this found?
- tantrums and meltdowns
- common in mild intellectual disorder
“Autistic Behaviors” most common in which degree of intellectual impairment?
Examples?
- moderate to severe
- self stimulating motor actions, obsessive interest in specific topics
Autism Spectrum disorder (ASD) scale
I (formerly aspergers) - III
3 diagnostic criteria for ASD
- impairment in reciprocal social interaction
- impairment in communication and imaginative activity
- restricted range of activities and interests
4 common social impairments of ASD
- lack social response
- lack eye contact
- lack interest in and response to affection
- lack response to emotion in others
Describe the progression of language development in patients with ASD; some features of their language habits (3)
Benign development–> drop off around age 2; may be mute
- Echolalia
- robotic/ abnormal intonation
2 important restricted activities and interests in patients with ASD (dietary? motor)
- limited food tolerance (sour cream and doritos?)
2. stereotyped motor behaviors (flapping, playing with hands/ fingers to self stimulate)
2 important sensory impairments of patients with ASD
- tactile defensiveness (don’t like jeans, etc.)
2. super hearing (the ice cream truck)
When are kids screened for ASD? One factor that puts kid at higher risk for ASD
18 mos
^ risk if have sibling with ASD
Typical IQ for patient with ASD
In general score below avg. but may be very intelligent
*Score effed up sometimes bc test is standardized & patient cannot communicate
Define sevantism
Below avg IQ + can perform singular task exceptionally well (Rainman)
Level 1 ASD
Typical IQ
Features of disease
Average to > Average IQ
Awkward socially, difficulty with organization and switching between activities
Level 2 ASD
Features of disease
more severe than type 1
*marked by ^^^er propensity for distress/ meltdown when required to change or redirect focus/attention
Level 3 ASD
Features of disease
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.
Accessory impairments to identify with ASD diagnosis
ASD +/- intellectual or language impairment
Rhett Disorder**
Describe course of disease
normal development up to 5 mos. –> deceleration of head growth 5-48 mos. –> impairment in social/language/motor function
*characterized by hand wringing
Treatment goals of ASD (3)–how is this achieved?
- Treat psych comorbidities with meds and therapy
- promote leaning and problem solving
- encourage normal development (social, cognition, etc.)
* Works best with interdisciplinary team
ADHD diagnostic criteria
*problems must span multiple environments (home + school)
ID: mild/moderate/severe
Three presentations of ADHS
- Hyperactive»»
- Inattentive»»
- combined presentation
Which presentation of ADHD gets the most referrals
hyperactive; due to disruption
Symptoms of inattention (6)
- poor attention to detail/ common careless mistakes
- poor attention during/ ability to organize tasks/ activities
- does not seem to listen when spoken to
- avoids dislikes+ activities that require sustained attention
- loses/ forgets things
- easily distracted by external stimuli
Which gender is more likely to have ADHD
M 3x > F
note that the inattentive subtype is more common in females and diagnosed later
Describe 2 neuropath features associated with ADHD
- Decreased perfusion and metabolism in frontal lobes
2. Altered dopamine receptors
first symptoms to remit in patients with ADHD; when does this typically occur
hyperactivity; typically occurs between 12-20 yo
How to manage ADHD (3):
- parental education and support
- create structured classroom/ learning environment (IEP, Section 504)
- Bx therapy or CBT
Define specific learning disorder (learning disability)
3 Categories?
Patient with NORMAL TO ABOVE AVG IQ*** performs at least two standard deviations below the mean academically
- reading/math/writing
- Specify mild/ moderate/ severe
Who gets learning disorders more, boys or girls?
What is one predictor?
M>F
Familial link
What must you exclude when diagnosing a learning disorder (4)
- neurological/ sensory/ motor causative issue
- intellectual deficit***
- lack of educational opportunity/ experience
- failure to respond to efforts to remediate
Common comorbidities with learning disorders; what is one important problem with these patients?
mood/ bx./ ADHD disorders
^^^ Dropout rate
motor tics: simple vs. complex examples
simple= jerks complex= skipping, squatting, smelling or touching others; appear intentional
vocal tics: simple vs. complex examples
simple= grunt, snort, snif, bark, squeal complex= words and phrases
Define a tic
involuntary, sudden, recurrent, non-rhythmic stereotyped motor or social bx. –urge for patient to do is compared to urge to sneeze
Two common comorbidities with tourettes disorder***
- ADHD
2. OCD
How does Tourette’s disorder differ from Persistent (Chronic) motor/vocal Tic Disorder?
Tourettes has BOTH motor and vocal; PCMVTD has one OR the other
In which sex is Tourettes disorder more common?
What is the mean age of onset?
M>F
Mean age of onset = 7yo
1 drug for treating Tourettes?
Tenex
When treating tourettes, what is meant by treating the hierarchy of sx?
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
Define Social Communication Disorder
Patients have difficulty with social verbal and nonverbal communication but are not on AS.
A communication disorder may be an early sign of what?
What type of problems might these kids have secondarily to the communication issues?
Learning disorder; may have secondary bx. problems
What is PICA and how does it present?
What type of patients does it typically effect?
Patients eat non-food objects for at least 1 mos
Generally patients of lower IQ
*Presents with GI complaints
Describe Rumination Disorder:
Typical patient hx?
How is it treated?
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
Conduct disorder:
What type of behavior problems do these patients have?
What are their relationships with others like?
What disease might this precipitate into?
Conduct = Crime
- Aggression/ destruction of property / theft/ serious rule violations
- Shallow relationships and attachments to others
- Possible precursor to antisocial personality disorder
Which sex is more likely to have conduct disorder?
Age of onset?
M > F
Childhood onset 10yo
5 common comorbidities with conduct disorder:
- poor academic performance
- substance abuse (early onset)
- Legal problems
- Learning disorders
- ADHD
Oppositional defiant disorder (ODD): how does it differ from conduct disorder?
Patients do not do criminal acts, but are argumentative, defiant, and vindictive for 6+ mos
(example = older sibling popping little sisters bday balloons)
3 Typical findings in hx of patient with oppositional defiant disorder
- does not understand limits/ transitions (tantrum in store if do not get what they want)
- Blame others for mistakes/ bx.
- no friends
How do we treat ODD? What two drugs might we use?
^ parenting skills, bx therapy for child
ADHD meds + mood stabilizers
Enuresis: definition + which is most common?
When is enuresis diagnosed?
Urination in time and place when inappropriate:
nocturnal > dinural (may present with both)
*NOT diagnosed before 5 yo
Bx treatment for nocturnal enuresis (2)
What is the thought behind these treatments?
Thought that patients sleep too soundly and do not wake up to stimulus for urination
- Bell and pad (pavlovian-classical)
- Ultrasonic Bladder Alarm
Encopresis: definition
When is it diagnosed?
Intentional > involuntary deification in time and place when inappropriate
*NOT diagnosed before 4 yo
How common is encopresis and with what is it typically associated?
What might you be concerned about if it is involuntary?
- Rare + asstd. with bx. disorders/ mental retardation
- If involuntary think sexual abuse
Define Separation Anxiety
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)
3 potential causative factors asstd. with separation anxiety?
- fear provoking experience
- phobic/ anxious parents
- genetics
How do we treat separation anxiety therapeutically and pharmacologically?
Bx therapy for anxiety management
SSRI + short term BDZ while taking effect
What is selective mutism
Severe anxiety disorder in which patients do not speak in specific situations (typically outside the home), but will speak normally otherwise
How do we manage selective mutism?
Psychotherapy in which patients are prompted with questions to which they must provide answer + anxiety meds
*Difficult disorder to treat
Disinhibited Social Engagement Disorder:
Cause
Features
- 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
Reactive Attachment Disorder:
Cause
Features
Cause = extremely insufficient care
Child is inhibited, socially withdrawn towards adult and caregivers + persistant social and emotional disturbance
Disinhibited Social Engagement Disorder +
Reactive Attachment Disorder: prognosis?
poor; very difficult to treat
Childhood Onset Dysfluency Disorder:
Fancy word for what?
Stuttering
“Triad” Disorder?
Tourettes
ADHD
OCD
How to treat dangerous tics that do not respond to tenex?
Haldol/ atypicals
severe ADRs so only used if tics cause self harm or harm to others.
“Splinter Function” describes?
savantism
Common reason parents associate autism with vaccination?
often assc with dropoff of speech development at age 2 (many vaccines given between 18-24 mos)
