Clin - Neurodevelopment Disorders Flashcards
what are the criteria for diagnosing intellectual disability (intellectual development disorder)
1) deficits in intellectual functions like reasoning, problem solving, planning, abstract thinking, judgment, academic learning
2) deficits in adaptive functioning resulting in failure to meet developmental and sociocultural standards for personal independence and social responsibility
3) onset of intellectual and adaptive deficits during the developmental period
describe deficits seen in the conceptual domain of adaptive functioning in an intellectual disability
preschoolers: language and pre-academic skills develop slowly
school age children: progress in reading, writing, math, and understanding of time and money
adults: academic skill is typically at elementary level
describe deficits seen in the social domain of adaptive functioning in an intellectual disability
- difficulty developing age-mates, immature in social situations
- difficulty accurately perceiving social cues
- communication, conversation, and language are more concrete, less mature
- difficulty regulating emotion and behavior
- immature social judgement
describe deficits seen in the practical domain of adaptive functioning in an intellectual disability
- difficulty with complex daily living tasks (grocery shopping, transportation, home and child care, food prep, money management)
- difficulty making good decisions about personal well-being and recreational activities
what are the criteria for diagnosing autism spectrum disorder
1) persistent deficits in social communication and social interaction
2) restricted, repetitive patterns of behavior, interests, or activities
3) sx must be present in early developmental period
4) sx cause clinically significant impairment in social, occupational, or other areas
5) disturbances are not better explained by an intellectual disability
describe the restricted, repetitive patterns of behavior, interests, or activities seen in autism
1) repetitive motor movements, use of objects, speech
2) insistence on sameness, inflexible adherence to routines
3) highly restricted, fixated interests that are abnormal in intensity or focus
4) hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
list the levels of severity of autism and how they are determined
severity is based on social communication impairments and restricted, repetitive patterns of behavior
level 3: requiring very substantial support
level 2: requiring substantial support
level 1: requiring support
what is the most consistently useful behavioral intervention in patients with autism spectrum disorder
education and support for parents, siblings, teachers, and caregivers
compare ADHD in females vs males
females present more commonly with the inattentive subtype than do boys
less disruptive behavior in females with ADHD may contribute to girls having fewer diagnoses than boys
what is the prevalence of adult ADHD
4.4%
only 10.9% received treatment
significantly more women received treatment for mental or substance problems 12 months before interview compared to men
adult ADHD is often comorbid with what other disorders
- mood disorders
- anxiety disorders
- substance disorders
- intermittent explosive disorder
describe the diagnostic criteria for tourette’s syndrome triad
- compare b/w boys and girls
- onset in childhood*
- duration >1 year*
- tics (motor and vocal)
- ADHD
- OCD
boys are more likely to have tics and girls are more likely to have OCD
what is the relationship between chronic tic disorder and ADHD
the prevalence of chronic tic disorder is higher in children with ADHD
what is the relationship between ADHD and childhood suicide
children: there is a closer relationship between ADHD and childhood suicide compared to depression/dysthymia
early adolescent decedents: vice versa
what is the pathophysiology behind problems with executive functioning
- dysfunction is within the prefrontal cortex
- primarily due to deficiency of dopamine and NE
what part of the brain is most consistently identified as a dysfunctional region in ADHD
dorsal anterior midcingulate cortex (daMCC)
what is the diagnostic criteria for ADHD (how many symptoms does each age range need?)
children: 6 or more symptoms
ages 17+: at least 5 symptoms
what are sx of the inattentive type of ADHD
- fails to give close attention to details or makes careless mistakes
- difficulty sustaining attention
- does not appear to listen
- struggles to follow through on instructions
- difficulty organizing
- loses things
- easily distracted
what are sx of the hyperactive type of ADHD
- fidgets w/ hands or feet or squirms in chair
- difficulty remaining seated
- runs/climbs excessively in children, restless in adulthood
- talks excessively
- blurts out answers before question is answered
- difficulty waiting or taking turns
what are the american academy of pediatrics clinical practice guidelines for treating ADHD in patients 4-5 years of age
first line:
evidence-based parent and/or teacher administered behavior therapy
prescribe methylphenidate if behavior therapy does not provide significant improvement
what are the american academy of pediatrics clinical practice guidelines for treating ADHD in patients 6-11 years of age
prescribe FDA approved meds and/or evidence-based parent and/or teacher administered behavior therapy
*preferably both meds and behavior therapy should be used together
what are the american academy of pediatrics clinical practice guidelines for treating ADHD in patients 12-18 years of age
prescribe FDA approved meds with consent of adolescent
may prescribe behavior therapy as treatment for ADHD
*preferably both meds and therapy together
what is the diagnostic criteria for stereotypic movement disorder
1) repetitive, seemingly driven, apparently purposeless motor behavior
2) repetitive motor behavior interferes w/ social, academic, or other activities and may result in self-injury
3) onset is in early developmental period
4) behavior not attributable to physiological effects of a substance or neurological condition
on top of the diagnosis of stereotypic movement disorder, what else do you need to specify
specify if:
- with self-injurious behavior
- without self-injurious behavior
- associate w/ a known medical or genetic condition, neurodevelopment disorder, or environmental factor
how to define severity of stereotypic movement disorder
mild: sx easily suppressed by sensory stimulus or distraction
moderate: sx require explicit protective measures and behavioral modification
severe: continuous monitoring and protective measures required to prevent serious injury
what is the diagnostic criteria for tourette’s disorder
1) both multiple motor tics and 1+ phonic tics must be present at some time during illness
2) tics must occur many times per day, nearly every day, or intermittently throughout period of more than a year
3) anatomical location, number, frequency, type, complexity, or severity of tics must change over time
4) onset of tics before age 21
5) involuntary movements and noises are not explained by other dx
6) tics must be witnessed by reliable examiner
what are some common comorbidities with tourette’s disorder
- ADHD
- OCD
- anxiety disorders
- mood disorders and risk of suicide
- disruptive behaviors
- learning disabilities and poor school performance
- sleep disorders
describe the comorbidity of ADHD with tourette’s syndrome
ADHD affects 30-60% of patients with TS
- sx of ADHD emerge 2-3 years BEFORE onset of tics
describe the comorbidity of OCD with tourette’s syndrome
OCD affects 10-50% of pts with TS
- sx of OCD emerge a few years AFTER onset of tics
describe the comorbidity of sleep disorders with tourette’s syndrome
50% pts with TS had sleep complaints
- motor tics recorded during sleep tests in 2/3 pts
what medications are used to treat tourette’s syndrome
- antidopaminergic drugs
- dopamine depleters
- antipsychotics
- alpha adrenergic agonists
- botulinum toxin injection
- anticonvulsants
what is the diagnostic criteria for persistent (chronic) motor or vocal tic disorder
1) single or multiple motor or vocal tics present during the illness
2) tics may wax and wane in frequency but have persistent for more than 1 year since onset
3) onset before age 18
4) not attributable to other condition
5) criteria have never been met for tourette’s
what do you need to specify for persistent (chronic) motor or vocal tic disorder
with motor tics only or with vocal tics only
what features of executive functioning must be evaluated when diagnosing ADHD
- ability to assess a situation
- prioritizing what is relevant vs irrelevant
- filtering out extraneous info
- make a plan how to act
- execute the plan
- assess the effect of action in a fluid manner
describe aspects of the TOVA test (test of variables of attention) for ADHD
- immediately available, easy to read report
- any personnel can be trained to administer test
- shorter test for young children
- language and culture-free testing
describe aspects of the conners continuous performance test for ADHD
- tests pts ages 8+
- indexes performance in inattentiveness, impulsivity, sustained attention, and vigilance
- time: 15 mins
what are the only FDA approved medications for irritability and agitation associated with autism
risperidone and ariprazole
what are the antidopaminergic drugs used to treat tourette’s syndrome
haloperidol, pimozide, and aripiprazole
what are the antipsychotics used to treat tourettes syndrome
fluphenazine and risperidone
what are the alpha adrenergic agonists used to treat tourettes syndrome
guanfacine and clonidine
what are the anticonvulsants used to treat tourettes syndrome
topiramate, valproic acid, gabapentin
