Clinical Approach to Neurodevelopmental and Attention Disorders

Question 1

When do NDDs typically manifest?

Answer 1

Often before the child enters grade school and are manifested by deficits in personal, social, academic or occupational functioning.

Question 2

What is the Intellectual Disability (Intellectual Developmental Disorder)?

Answer 2

Global developmental delay

Question 3

What are the 4 Communication Disorders?

Answer 3

Language disorder

Speech sound disorder

Childhood-onset fluency disorder (Stuttering)

Social (Pragmatic) communication disorder

Question 4

What is a type of ADHD?

Answer 4

Specific learning disorder

Question 5

What are 3 Motor Disorders?

Answer 5

Developmental coordination disorder

Stereotypic movement disorder

Tic disorders

Question 6

What is required for a diagnosis of intellectual development disorder? (3)

When is global developmental delay diagnosed?

Answer 6

1. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning/learning from experience.
2. Deficits in adaptive functioning that result in failure to developmental and sociocultural standards for personal independence and social responsibility. They require ongoing support.
3. Onset of deficits is during developmental period.

GDD is diagnosed in pts. who are unable to undergo systematic assessments of intellectual functioning:

• child is too young to participate
• insults during developmental period
• severe head injury

Question 7

What are the 3 domains of adaptive functioning deficits?

Answer 7

Conceptual domain

Social domain

Practical domain

Question 8

Assessment of speech, language and communication abilities must take what into account?

Answer 8

The pts. cultural and language context.

Question 9

What 4 characteristics describe Language disorder?

Answer 9

1. Persistent difficulties in the acquisition and use of language across modalities due to problems with comprehension or production, including: reduced vocab, limited sentence structure, impairments in discourse.
2. Language abilities are substantially and quantifiably below those expected for age.
3. Onset is in early developmental period.
4. The deficits are not attributable to a hearing or other sensory impairment, motor dysfunction or other neurological condition.

Question 10

What are 4 features of speech sound disorder?

Answer 10

1. Persistent difficulty with speech sound production that impairs communication.
2. The disturbance causes limitations in effective communication that interfere with all parts of life.
3. Onset is during early developmental period.
4. The difficulties are not attributable to congenital or acquired conditions (cerebral palsy, cleft palate, deafness, etc.).

Question 11

What are 4 features of childhood-onset fluency disorder (stuttering)?

Answer 11

1. Disturbances in normal fluency and timing of speech that are inappropriate for a given age.
2. The disturbance causes anxiety about speaking or limitations about effective communication.
3. Onset is during early developmental period.
4. The disturbance is not attributable to a speech-motor or other sensory deficit, or other condition.

Question 12

What are 4 features of social (pragmatic) communication disorder?

Answer 12

1. Persistent difficulties in the social use of verbal and non-verbal communication as manifested by the following: inability to have socially appropriate discourse, ability to change communication to match context, trouble following rule for storytelling, conversation, etc., trouble making inferences.
2. Deficits result in functional limits in effective communication, participation, relationships, etc.
3. Onset is in early developmental period.
4. Symptoms are not attributable to another condition.

Question 13

What is the most common associated feature of social (pragmatic) communication disorder?

Milder forms might not manifest until when?

Answer 13

Delay in reaching language milestones

Early adolescents, when language and social interactions become more complex

Question 14

What are the 5 features of autism spectrum disorder?

Answer 14

1. Persistent deficits in social communication and social interaction across multiple contexts (social reciprocity, problems with non-verbal communications, problems developing/maintaining relationships).
2. Restricted, repetitive patterns of behavior, interests or activities (repetitive movements, insistence on sameness, narrowed unusual interests, hyper- or hypo-interest in sensory aspects (sounds, textures, etc.)).
3. Onset must be in early developmental period.
4. Symptoms cause significant social, occupational, and other types of impairment.
5. The symptoms are not better explained by another intellectual disability.

Question 15

Severity of autism spectrum disorder is based on what?

What are the 3 levels (1, 2, 3)?

Answer 15

Social communication impairments and restricted, repetitive patterns of behavior.

Level 3 - requiring very substantial support
Level 2 - requiring substantial support
Level 1 - requiring support

Question 16

What is the most consistently useful behavioral interventions in autism (2)

Answer 16

Education and support for parents, siblings, teachers, etc.

Learning about “parallel” processing and how to apply it. Parallel processing is the ability of the brain to do many things (aka, processes) at once. For example, when a person sees an object, they don’t see just one thing, but rather many different aspects that together help the person identify the object as a whole.

Question 17

What are the only medications approved for the irritability and agitation associated with autism? (2)

Which others have shown efficacy as well?

Answer 17

Risperidone and Aripiprazole

Valproic acid, Gabapentin, Stimulants, a-agonists, antidepressants.

Question 18

Females with ADHD present commonly with which subtype?

Answer 18

Inattentive subtype

Question 19

Less disruptive behavior in females with ADHD may contribute to what?

Answer 19

Referral bias causing under-identification and lack of treatment for females with ADHD.

Question 20

What comorbidities are associated with Adult ADHD?

Which sex is more likely to get treatment?

Answer 20

Psychiatric disorders: mood disorders (most likely), anxiety disorders, substance disorders, and intermittent explosive disorder.

Males, but it is still under-treated.

Question 21

What is Tourette’s syndrome?

What is the triad?

Answer 21

Onset of multiple motor and vocal tics lasting > 1 year.

Tics, ADHD and OCS.

Question 22

Chronic tic disorder has a higher risk in children with what?

Answer 22

ADHD - confers additional psychiatric and functional burden.

It must be considered in initial and ongoing management of kids w/ ADHD.

Question 23

What is the association of ADHD and suicide?

Answer 23

Children committing suicide with known mental illnesses more often experienced ADHD and less often experienced depression/dysthymia.

Question 24

Problems with executive functioning arise from where in the brain?

It is due to a deficiency of what?

Answer 24

Informational processing dysfunction within the prefrontal cortex.

Deficiency of DA and NE.

Question 25

What region has been diagnosed as dysfunctional in ADHD most consistently?

Answer 25

Dorsal anterior midcingulate cortex (daMCC)

Question 26

What is the DSM-5 diagnostic criteria for ADHD in children (< 17 y/o)?

What is it in people > 17 y/o?

Answer 26

Children < 17 y/o must have 6 or more symptoms.

People > 17 y/o should have at least 5 symptoms.

Question 27

Describe the Inattentive vs, Hyperactive types of ADHD?

Answer 27

Inattentive: careless mistakes, trouble sustaining attention, avoids tasks, loses things, distracted. poor listening skills.

Hyperactive: fidgets, can’t stay seated, runs/climbs, talks a lot, trouble waiting/taking turns.

Question 28

What is the major use of the Test of Variables of Attention (TOVA) for ADHD?

What are some benefits of it?

Answer 28

It is a shorter test for young children.

Language and culture-free testing.
Normed by gender from 4-80+ y/o.
Immediately available.
Home and school strategies for treatment options.
Any personnel can administer it.

Question 29

What is the Conner’s Continuous Performance Test for ADHD?

How long does it take to administer?

What is the test taken on?

Answer 29

A task-oriented assessment of attention-related problems in pts. > 8 y/o.

Approx. 15 min.

Laptop - subject uses mouse and space bar to respond.

Question 30

What are the AAP clinical practice guidelines for preschool-aged children (4-5 y/o)? (2)

Answer 30

Prescribe evidence-based parent and/or teacher-administered behavior therapy as 1st line therapy.

Prescribe methylphenidate if the behavior therapy does not improve.

Question 31

What are the AAP clinical practice guidelines for elementary school-aged children (6-11 y/o)? (1)

Answer 31

Prescribe FDA approved meds for ADHD and/or Prescribe evidence-based parent and/or teacher-administered behavior therapy (but preferably together).

Question 32

Prescribe evidence-based parent and/or teacher-administered behavior therapy for adolescents (12-18 y/o)? (1)

Answer 32

Prescribe FDA approved meds for ADHD and/or Prescribe evidence-based parent and/or teacher-administered behavior therapy (but preferably together).

Question 33

What is the major concern of using Bupropion?

Answer 33

SEIZURES are a major side-effect!

Question 34

Who is Modafinil only used in?

Answer 34

Adults only

Question 35

What is the MOA of Methylphenidate?

What has been associated with after 6 years of use?

Answer 35

Increases extracellular DA levels in the brain, blocking the DA transporters in the synapse.

Transient increases in prevalence of anxiety and depression.

Question 36

What are 4 features of Developmental Coordination Disorder?

Answer 36

1. Acquisition and execution of coordinated motor skills is substantially below that expected given the pts. age. Difficulties are manifested as clumsiness, slowness, inaccuracy, etc.
2. The motor skills persistently interfere with daily living and impacts school, vocation, lesiure, play, etc.
3. Onset of symptoms is in early developmental period.
4. The motor skill deficits are not better explained by an intellectual disability or visual impairment or neurological defect.

Question 37

What are 4 features of Stereotypic Movement Disorder?

Answer 37

1. Repetitive, seemingly drive, and apparently purposeless motor behavior (body rocking, head banging, hitting themselves, etc.).
2. Those features interfere with social, academic or other activities.
3. Onset is in early developmental period.
4. Repetitive movements are not better explained by something else.

Question 38

Stereotypic Movement Disorder must be specified if: (3)

What are mild, moderate and severe forms?

Answer 38

With self-injurious behavior
Without self-injurious behavior
Associated with a known condition

Mild: symptoms are easily suppressed by sensory stimulus or distraction.
Moderate: symptoms require explicit protective measures and behavioral modifications.
Severe: pt. requires constant monitoring and protective measures to prevent serious injury.

Question 39

What are the 5 features of Persistent (Chronic) Motor or Vocal Tic Disorder?

It must be specified if:

Answer 39

1. Single or multiple motor or vocal tics have been present during the illness, but not both.
2. Tics may wax and wane in frequency but have persisted for > 1 year.
3. Onset is before 18 y/o.

D. The disturbance is no attributable to the physiological effects of a substance or other condition.

E. Criteria has never been met for Tourette’s disorder.

With motor tics only OR with vocal tics only.