Clinical Approach to Neurodevelopmental Disorders Flashcards
what is global developmental delay
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
intellectual disability look for adaptive functioning deficits in what 3 areas:
- conceptual
- social
- practical
what is the conceptual deficit in intellectual disability?
reasoning, problem solving, planning, abstract thinking, judgement, academic learning, learning from experience
what is the social deficit in intellectual disability
difficulty making friends and reading social cues, language is more concrete, difficulty controlling emotions and behaviors in social situations, easily manipulated
what is the practical deficit in intellectual disability?
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
in preschooler what signs/symptoms should you look for in intellectual disability?
language and pre-academic skills that are developing slowly
in school aged children what signs/symptoms should you be looking for in intellectual disability?
progress in reading, writing, mathematics, concepts of time/money lags behind
in adults what signs/symptoms are you looking for in intellectual disability?
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
what are the two commonly used diagnostic tools for intellectual disability
Denver Developmental Screening Test (DDST)
Wechsier Intelligente Schale for Children 5th edition
What diagnostic tool assess four functions: gross motor, language, fine motor-adaptive, and personal social
-screening tool in primary care
(intellectual disability)
DDST- Denver developmental screening test
what diagnostic tool is an intelligence test that measures a Childs intellectual ability
-preformed by health services clinical psychologist
(intellectual disability)
Wechsier intelligence scale for children 5th edition
diagnostic tools used for intellectual disability makes a diagnosis based on _, not IQ scores
adaptive functioning
what are the 4 types of communication disorders?
- language disorder
- speech sound disorder
- social communication disorder
- childhood onset fluency disorder- stuttering
Language disorder has to do with the use of spoken _ , sign language, written words, and pictures
words
speech sound disorder has to do with the necessary articulation and resonance quality for speech _
sounds
social communication disorder has to do with verbal and non verbal behavior for _ _
social interaction
childhood-onset fluency disorder (stuttering) has to do with the _ of patterns of speech sounds
fluency
what should you be looking for in a language disorder
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
what should you be looking for in speech sound disorder ?
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
what are you looking for in Social (pragmatic) communication disorder?
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.
what are you looking for in childhood onset fluency disorder (stuttering)
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
Autism Spectrum Disorder what to look for (7 things)
- deficits in social-emotional reciprocity
- deficits in nonverbal communicative behaviors used for social interaction
3.deficits in developing, maintains, and understanding relationships - stereotyped or repetitive motor movements, use of objects, or speech
- insistence on the sameness, routine, rituals
6.intense fixations on highly restricted range or interests - ABNORMAL REACTION TO SENSORY INPUT (sensory integration deficits)
examples of social-emotional reciprocity deficit in a kid with autism
failure of normal back and forth conversation
reduced sharing of interests, emotion, or affect
failure to initiate or response to social interactions
examples of non verbal communicative behaviors in social interaction deficits in a kid with autism
poorly integrated verbal and non verbal communication
lack of meaningful eye contact
limited use of body language/gestures/facial expression
examples of developing, maintain, and understanding relationships deficit in a kid with autism
adjusting behavior to suit various social contexts
sharing imaginative play or making friends
absence of interest in peers
examples of stereotypes or repetitive motor movement, use of object or speech deficits in a kid with autism
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
what is a idiosyncratic phrase
a phrase that only has meaning to the person
examples of insistence on sameness, routine, or rituals in a kid with autism
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
examples of intense fictions on a highly restricted range of interests in a kid with autism
strong attachment to or preoccupation with unusual objects
intense fascination with a very narrow range of interests
examples of abnormal reaction to sensory input (hyper/hyporeactivity) in a kid with autism
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
one of the most distinctive features of autism is?
sensory integration deficits
the heterogeneity of autism spectrum disorders is due to _ and _ variables and various co-occurring _ disorders
genetics
environmental
neurodevelopmental
The DSM5 criteria that best differentiate intellectual disability from Autism spectrum disorder are _ and _
restricted interests and repetitive behaviors
What are some behavioral interventions for autism spectrum disorders
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
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
-
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
-
what drugs are the only FDA approved autism spectrum disorder drugs for irritability and agitation
risperidone and aripiprazole
what other medications are effective in the treatment for irritability and agitation in people with autism ?
-not FDA approved
valproic acid
gabapentin
stimulants
central alpha 2 receptor agonists
antidepressants
what other medications are effective in the treatment for irritability and agitation in people with autism ?
-not FDA approved
valproic acid
gabapentin
stimulants
central alpha 2 receptor agonists
antidepressants
what is ADHD
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
what is the most commonly misdiagnosed neurodevelopment disorder?
ADHD (attention-deficit/hyperactivity disorder)
females with ADHD present more commonly with the _ subtype
inattentive
less disruptive behavior in _ with ADHD may contribute to referral bias causing under identification and lack of treatment
females
what is the most common cause of attention and concentration problems
mood disorder along with ADHD
ADHD has comorbities with what other disease processes ?
mood disorders, anxiety disorder, substance use disorder, intermittent explosive disorder, Tic disorders, specific learning disorders
the potential for tics can be exacerbated by _ medications
stimulant
Tourette syndrome is defined by ?
childhood onset of multiple motor and vocal tics lasting more than one year
ADHD,OCD, and Tourettes
ADHD and childhood suicide
higher rates than with rates of depression ?
ADHD is an information processing dysfunction within the ?
prefrontal cortex
-dorsal anterior midcingulate cortex
ADHD is primarily due to a deficiency of ?
dopamine and norepinephrine
what are the 3 types of ADHD
inattentive type
hyperactive type
combined type
ADHD DSM-V diagnostic criteria
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
what are the 6 symptoms of ADHD inattentive type
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
ADHD hyperactive type 6 symptoms
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
what are some ADHD diagnostic tools?
computerized test: TOVA, Conners continuous performance test, QB test
standardized checklists: Vanderbilt, conners ADHD scale, conners adult ADHD rating scales ( self reported)
for preschool aged (4-5) children what is the protocol for treating ADHD
behavior management
prescribe methylphenidate if the child continues to have moderate to severe symptoms
for elementary school children (6-11) what is the protocol for treating ADHD
both FDA medication and behavior management is the protocol
for adolescents (12-18) what is the protocol for treating ADHD
both FDA medication and behavior management is the protocol
what are the common medications for ADHD
Bupropion
A2 adrenergic agonists: guanifacine and clonidine
Atomoxetine
Modafinil
methylphenidate
amphetamine salts
burin may increase the risk of?
seizure
atomoxetine MOA
a selective inhibitor of presynaptic norepinephrine reuptake
guanfacine and clonidine have the ability to modulate _ tone
noradrenergic tone
Modafinil MOA
binds to dopamine transporter and inhibits dopamine reuptake
which ADHD drug is for adults only
Modafinil
methylphenidate MOA
increases extracellular dopamine levels in the brain by blocking dopamine transports in synapse
amphetamine salts MOA
inhibits norepinerpirne reuptake and stimulates post synaptic release of noreepinerphrine
what are the 3 types of motor disorders?
developmental coordination disorder
stereotypic movement disorder
tic disorder (2 subcategories- tourettes, persistent motor or vocal tic)
what are the 2 subcategories or tic disorders
toureettes disorder
chronic motor or vocal tic disorder
problems with coordinated motor skills such as clumsiness, catching an. object, problems using scissors, handwriting, riding a bike
Developmental coordination disorder
what is developmental coordination disorder
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
repetitive, compulsive, and purposeless motor behavior that interferes with social, academic, and other activities that may result in self injury
stereotypic movement disorder
what is stereotypical movement disorder
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
a sudden rapid recurrent nonrhythmic motor movement of vocalization
Tic
multiple motor tics and one or more phonic tic that is present at some time during the illness but not necessarily concurrent
tourrettes disorder
touchettes disorder
tics must occur?
anatomical location of tic must?
onset before the age of ?
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
_ affects 30 to 60 percent of patients with TS symptoms of ADHD often emerge two to three years before the onset of TICS
ADHD
_ 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
OCD
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 _
suicide
what are the other comorbities associated with toureetes disorder
disruptive behaviors, learning disabilities and poor school performance, sleep disorders
Tourette’s disorder medications
antidopaminergic drugs
dopamine depleters
antipsychotics
alpha 2 adrenergic agonists
botulism toxin injection
anticonvulsants
what are the approved antidopaminergic drugs for the treatment of TD are?
haloperidol, pimozide, and arpiprazole
antidopaminergic drugs may cause
tardive dyskinesia
dopamine deleters MOA
delete dopamine by inhibiting vesicular monoamine transporter type 2 (VMAT2)
***does not cause tar dive dyskinesia
dopamine depleters drug in the class
respiring, tetrabenazine, deuterabenaine,
valbenazine
benzine SNRI
antisychotics for tourettes disorder
fluphenazine, and risperidone
alpha 2 adrenergic agonists for tourettes
guanfacine and clonidine
botulism toxin injection in tourettes is used for?
focal motor and phonic tics
anticonculsants for tourettes disorder drugs in class
topiramate, valproic acid, gabapentin
what is persistent motor/vocal tic disorder
single or multiple motor OR vocal tics have been presenting during the illness
but not both motor and vocal
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
persistent chronic motor or vocal tic disorder
What are the three areas that a child with Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure
- trouble with thinking and memory (trouble planning or forget material that she has already learned)
- behavior problems (tantrums or mood issues) /difficulty shifting between tasks
- trouble with day tp day living like with bathing, dressing or playing with other children
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
30
30 day
2/sitting
Behavioral problems associated with Fetal Alcohol syndrome
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
what is a philtrum
smooth ridge between the nose and the upper lip
