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NMSP Exam 3 > Clinical Approach to Neurodevelopmental Disorders > Flashcards

Clinical Approach to Neurodevelopmental Disorders Flashcards

1
Q

what is global developmental delay

A

this is a diagnosis that is given to someone when they meet the diagnostic criteria of intellectual disability disorder but they cannot be diagnosed as such due to confounds of any of the following below

-cannot participate in standardized assessment of intellectual functioning suck as deaf or blind
-too young to participate in standardized testing
-have an acquired illness or physical insult during the developmental period that could also disrupt normal development like a head injury

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2
Q

intellectual disability look for adaptive functioning deficits in what 3 areas:

A
  1. conceptual
  2. social
  3. practical
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3
Q

what is the conceptual deficit in intellectual disability?

A

reasoning, problem solving, planning, abstract thinking, judgement, academic learning, learning from experience

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4
Q

what is the social deficit in intellectual disability

A

difficulty making friends and reading social cues, language is more concrete, difficulty controlling emotions and behaviors in social situations, easily manipulated

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5
Q

what is the practical deficit in intellectual disability?

A

difficulty in personal care, grocery shopping, transportation, home and child care, food preparation, will need help raising a family , making health care and legal decisions

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6
Q

in preschooler what signs/symptoms should you look for in intellectual disability?

A

language and pre-academic skills that are developing slowly

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7
Q

in school aged children what signs/symptoms should you be looking for in intellectual disability?

A

progress in reading, writing, mathematics, concepts of time/money lags behind

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8
Q

in adults what signs/symptoms are you looking for in intellectual disability?

A

academic skills at an elementary level, need of support in personal life and academic skills, care givers need to take over responsibilities fully for the person

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9
Q

what are the two commonly used diagnostic tools for intellectual disability

A

Denver Developmental Screening Test (DDST)

Wechsier Intelligente Schale for Children 5th edition

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10
Q

What diagnostic tool assess four functions: gross motor, language, fine motor-adaptive, and personal social

-screening tool in primary care

(intellectual disability)

A

DDST- Denver developmental screening test

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11
Q

what diagnostic tool is an intelligence test that measures a Childs intellectual ability

-preformed by health services clinical psychologist

(intellectual disability)

A

Wechsier intelligence scale for children 5th edition

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12
Q

diagnostic tools used for intellectual disability makes a diagnosis based on _, not IQ scores

A

adaptive functioning

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13
Q

what are the 4 types of communication disorders?

A
  1. language disorder
  2. speech sound disorder
  3. social communication disorder
  4. childhood onset fluency disorder- stuttering
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14
Q

Language disorder has to do with the use of spoken _ , sign language, written words, and pictures

A

words

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15
Q

speech sound disorder has to do with the necessary articulation and resonance quality for speech _

A

sounds

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16
Q

social communication disorder has to do with verbal and non verbal behavior for _ _

A

social interaction

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17
Q

childhood-onset fluency disorder (stuttering) has to do with the _ of patterns of speech sounds

A

fluency

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18
Q

what should you be looking for in a language disorder

A

difficulty with spoken, writing, and sign language due to reduced vocabulary, limited ability to put words and word ending together to form sentences

-language abilities that are below the expected age

-a genetic component that would predispose to the developmental disorder

-difficulty not due to a sensory, motor, neurologic reason

-foreign status

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19
Q

what should you be looking for in speech sound disorder ?

A

difficulty making speech sounds that are intelligible which will limit verbal communication

-difficulty making the correct sounds for consonants and vowels

  • interferences with social participation, academic achievement, and occupational performance

-NOT attributable to congenital or acquired conditions like cerebral palsy or cleft palate, or foreign status

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20
Q

what are you looking for in Social (pragmatic) communication disorder?

A

difficulty with social use of verbal and nonverbal communication

-sharing information as appropriate for the social setting

-speaking differently in the classroom than on –

-the playground
talking differently to an adult vs a child

  • difficulty understanding inferences, idioms, humor, metaphors etc.
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21
Q

what are you looking for in childhood onset fluency disorder (stuttering)

A

difficulty with fluency and patterns of speech sound

-sound prolongations, pause within a word, audible silent pauses, word substation to avoid problematic words, words produced with excessive physical tension, monosyllabic whole word repetitions

this can cause anxiety about speaking and limits communication, participation, and academic performance

-NOT attributable to neurologic problem or another mental condition

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22
Q

Autism Spectrum Disorder what to look for (7 things)

A
  1. deficits in social-emotional reciprocity
  2. deficits in nonverbal communicative behaviors used for social interaction
    3.deficits in developing, maintains, and understanding relationships
  3. stereotyped or repetitive motor movements, use of objects, or speech
  4. insistence on the sameness, routine, rituals
    6.intense fixations on highly restricted range or interests
  5. ABNORMAL REACTION TO SENSORY INPUT (sensory integration deficits)
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23
Q

examples of social-emotional reciprocity deficit in a kid with autism

A

failure of normal back and forth conversation

reduced sharing of interests, emotion, or affect

failure to initiate or response to social interactions

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24
Q

examples of non verbal communicative behaviors in social interaction deficits in a kid with autism

A

poorly integrated verbal and non verbal communication
lack of meaningful eye contact
limited use of body language/gestures/facial expression

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25
Q

examples of developing, maintain, and understanding relationships deficit in a kid with autism

A

adjusting behavior to suit various social contexts

sharing imaginative play or making friends

absence of interest in peers

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26
Q

examples of stereotypes or repetitive motor movement, use of object or speech deficits in a kid with autism

A

finger flapping, spinning around, walking on toes

obsessively living up toys or rearranging objects

echolalia (repetition/echoing of words/sounds that an individual hears)

idiosyncratic phrases

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27
Q

what is a idiosyncratic phrase

A

a phrase that only has meaning to the person

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28
Q

examples of insistence on sameness, routine, or rituals in a kid with autism

A

extreme distress at small things

difficulty at small changes

rigid thinking patterns, goodbye and greeting meetings

need to eat the same food everyday take the same route

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29
Q

examples of intense fictions on a highly restricted range of interests in a kid with autism

A

strong attachment to or preoccupation with unusual objects

intense fascination with a very narrow range of interests

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30
Q

examples of abnormal reaction to sensory input (hyper/hyporeactivity) in a kid with autism

A

overreaction or under reaction

apparent indifference to pain/temp

prone to sensory overload that can cause agitation or melt downs

adverse response to specific sounds/textures

excessive smelling or touching of objects

visual fascination with lights or movement

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31
Q

one of the most distinctive features of autism is?

A

sensory integration deficits

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32
Q

the heterogeneity of autism spectrum disorders is due to _ and _ variables and various co-occurring _ disorders

A

genetics

environmental

neurodevelopmental

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33
Q

The DSM5 criteria that best differentiate intellectual disability from Autism spectrum disorder are _ and _

A

restricted interests and repetitive behaviors

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34
Q

What are some behavioral interventions for autism spectrum disorders

A

education and support for parents, siblings etc.

learning about the parallel process and learning how to use it for behavioral management

controlling the environment to limit sensory overload

allow for difficulty with transitions

desensitization programs

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35
Q

adults who have developed compensation strategies for some social challenges stills struggle in novel or unsupported situations and differ from the effort and anxiety of consciously calculating what is intuitive for most individuals

A

-

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36
Q

many adults with autism spectrum disorder without intellectual or language disabilities learn to suppress repetitive behavior in public, special interests may be a source of pleasure and motivation

A

-

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37
Q

what drugs are the only FDA approved autism spectrum disorder drugs for irritability and agitation

A

risperidone and aripiprazole

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38
Q

what other medications are effective in the treatment for irritability and agitation in people with autism ?

-not FDA approved

A

valproic acid

gabapentin

stimulants

central alpha 2 receptor agonists

antidepressants

39
Q

what other medications are effective in the treatment for irritability and agitation in people with autism ?

-not FDA approved

A

valproic acid

gabapentin

stimulants

central alpha 2 receptor agonists

antidepressants

40
Q

what is ADHD

A

executive function deficits that interfere with the ability to gain, sustain, and shift focus

-problems in assessing situation, prioritizing what is irrelevant vs what is irrelevant, filtering out extraneous information, exciting the plan to completion

41
Q

what is the most commonly misdiagnosed neurodevelopment disorder?

A

ADHD (attention-deficit/hyperactivity disorder)

42
Q

females with ADHD present more commonly with the _ subtype

A

inattentive

43
Q

less disruptive behavior in _ with ADHD may contribute to referral bias causing under identification and lack of treatment

A

females

44
Q

what is the most common cause of attention and concentration problems

A

mood disorder along with ADHD

45
Q

ADHD has comorbities with what other disease processes ?

A

mood disorders, anxiety disorder, substance use disorder, intermittent explosive disorder, Tic disorders, specific learning disorders

46
Q

the potential for tics can be exacerbated by _ medications

A

stimulant

47
Q

Tourette syndrome is defined by ?

A

childhood onset of multiple motor and vocal tics lasting more than one year

ADHD,OCD, and Tourettes

48
Q

ADHD and childhood suicide

A

higher rates than with rates of depression ?

49
Q

ADHD is an information processing dysfunction within the ?

A

prefrontal cortex

-dorsal anterior midcingulate cortex

50
Q

ADHD is primarily due to a deficiency of ?

A

dopamine and norepinephrine

51
Q

what are the 3 types of ADHD

A

inattentive type

hyperactive type

combined type

52
Q

ADHD DSM-V diagnostic criteria

A

children should have 6 or more from the category

people 17 and older should have at least 5

combined type must meet the full criteria for both the initiative and hyperactive type

53
Q

what are the 6 symptoms of ADHD inattentive type

A

fails to give close attention to details/makes careless mistakes

has difficulty sustaining attentino

does not appear to listen

struggles to follow through on instructions

has difficulty with organization

avoids/dislikes tasks requiring a lot of thinking

loses things

easily distracted

is forgetful in daily activities

54
Q

ADHD hyperactive type 6 symptoms

A

fidgets with feet or squirms in chair

difficulty remaining seating

runs about of climbs excessively in children

engaging in activities quietly is hard

acts if driven by a motor

talk excessively

blurts about answers before questions have been completed

difficulty waiting or taking turns

55
Q

what are some ADHD diagnostic tools?

A

computerized test: TOVA, Conners continuous performance test, QB test

standardized checklists: Vanderbilt, conners ADHD scale, conners adult ADHD rating scales ( self reported)

56
Q

for preschool aged (4-5) children what is the protocol for treating ADHD

A

behavior management

prescribe methylphenidate if the child continues to have moderate to severe symptoms

57
Q

for elementary school children (6-11) what is the protocol for treating ADHD

A

both FDA medication and behavior management is the protocol

58
Q

for adolescents (12-18) what is the protocol for treating ADHD

A

both FDA medication and behavior management is the protocol

59
Q

what are the common medications for ADHD

A

Bupropion

A2 adrenergic agonists: guanifacine and clonidine

Atomoxetine

Modafinil

methylphenidate

amphetamine salts

60
Q

burin may increase the risk of?

A

seizure

61
Q

atomoxetine MOA

A

a selective inhibitor of presynaptic norepinephrine reuptake

62
Q

guanfacine and clonidine have the ability to modulate _ tone

A

noradrenergic tone

63
Q

Modafinil MOA

A

binds to dopamine transporter and inhibits dopamine reuptake

64
Q

which ADHD drug is for adults only

A

Modafinil

65
Q

methylphenidate MOA

A

increases extracellular dopamine levels in the brain by blocking dopamine transports in synapse

66
Q

amphetamine salts MOA

A

inhibits norepinerpirne reuptake and stimulates post synaptic release of noreepinerphrine

67
Q

what are the 3 types of motor disorders?

A

developmental coordination disorder

stereotypic movement disorder

tic disorder (2 subcategories- tourettes, persistent motor or vocal tic)

68
Q

what are the 2 subcategories or tic disorders

A

toureettes disorder

chronic motor or vocal tic disorder

69
Q

problems with coordinated motor skills such as clumsiness, catching an. object, problems using scissors, handwriting, riding a bike

A

Developmental coordination disorder

70
Q

what is developmental coordination disorder

A

problems with coordinated motor skills such as clumsiness, catching an. object, problems using scissors, handwriting, riding a bike

that interferes with self care, school, activities

and is not caused by any other neurological condition

71
Q

repetitive, compulsive, and purposeless motor behavior that interferes with social, academic, and other activities that may result in self injury

A

stereotypic movement disorder

72
Q

what is stereotypical movement disorder

A

repetitive, compulsive, and purposeless motor behavior that interferes with social, academic, and other activities that may result in self injury

not explained by another disease process like trichotillomania, OCD< tic disorder

73
Q

a sudden rapid recurrent nonrhythmic motor movement of vocalization

A

Tic

74
Q

multiple motor tics and one or more phonic tic that is present at some time during the illness but not necessarily concurrent

A

tourrettes disorder

75
Q

touchettes disorder

tics must occur?

anatomical location of tic must?

onset before the age of ?

A

many times a day, nearly everyday, or intermittently thoughout at a period of more than 1 a year

anatomical location, number, frequency, type, complexity, and severity must change over time

before onset age 18

**must be witnessed by a reliable examiner at some point/recorder/videotaped

76
Q

_ affects 30 to 60 percent of patients with TS symptoms of ADHD often emerge two to three years before the onset of TICS

A

ADHD

77
Q

_ affects 10-50 percent of patients with symptoms typically emerge a few years after the onset of tics and often become more severe over time

A

OCD

78
Q

patients with TS have an increased risk of mood disorders with a lifetime prevalence of approximately 30 years. People with Tourettes disorder or chronic tic disorder are over 4 times more likely to die by _

A

suicide

79
Q

what are the other comorbities associated with toureetes disorder

A

disruptive behaviors, learning disabilities and poor school performance, sleep disorders

80
Q

Tourette’s disorder medications

A

antidopaminergic drugs

dopamine depleters

antipsychotics

alpha 2 adrenergic agonists

botulism toxin injection

anticonvulsants

81
Q

what are the approved antidopaminergic drugs for the treatment of TD are?

A

haloperidol, pimozide, and arpiprazole

82
Q

antidopaminergic drugs may cause

A

tardive dyskinesia

83
Q

dopamine deleters MOA

A

delete dopamine by inhibiting vesicular monoamine transporter type 2 (VMAT2)

***does not cause tar dive dyskinesia

84
Q

dopamine depleters drug in the class

A

respiring, tetrabenazine, deuterabenaine,

valbenazine

benzine SNRI

85
Q

antisychotics for tourettes disorder

A

fluphenazine, and risperidone

86
Q

alpha 2 adrenergic agonists for tourettes

A

guanfacine and clonidine

87
Q

botulism toxin injection in tourettes is used for?

A

focal motor and phonic tics

88
Q

anticonculsants for tourettes disorder drugs in class

A

topiramate, valproic acid, gabapentin

89
Q

what is persistent motor/vocal tic disorder

A

single or multiple motor OR vocal tics have been presenting during the illness

but not both motor and vocal

90
Q

the tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset

onset is before 18 years old

not attributable to the physiological effects of a substance or another medical condition

criteria has not been met for Tourettes disorder

  • pathology
A

persistent chronic motor or vocal tic disorder

91
Q

What are the three areas that a child with Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure

A
  1. trouble with thinking and memory (trouble planning or forget material that she has already learned)
  2. behavior problems (tantrums or mood issues) /difficulty shifting between tasks
  3. trouble with day tp day living like with bathing, dressing or playing with other children
92
Q

To be DIAGNOSED with Neurobehavioral disorder associated with prenatal alcohol exposure the mother of the child must have consumed more than _ drinks per month during a _ day period of pregnancy with more the _ alcoholic drinks in one sitting

A

30

30 day

2/sitting

93
Q

Behavioral problems associated with Fetal Alcohol syndrome

A

poor coordination, hyperactive behavior, poor memory, difficulty in school, sleep and sucking problems, small head, abnormal facial features (philtrum) , vision or hearing problems, poor reading and judgement

94
Q

what is a philtrum

A

smooth ridge between the nose and the upper lip

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