Clinical Approach to Neurodevelopmental and Attention Disorders Flashcards
children with intellectual disabilities have deficits in 3 domains:
conceptual
social
practical
conceptual domain
reasoning problem-solving planning abstract thinking judgment academic learning learning from experience
social domain
immature in social interactions difficulty with social cues less mature conversation difficulty with emotion and behavior immature social judgment - at risk for being manipulated
practical domain
difficulty with age-appropriate personal care
cannot perform daily tasks without assistance
difficulty making good decisions about well-being
employment restrictions
need help with health care and legal decisions
preschoolers with ID demonstrate:
slowly develop language and pre-academic skills
school-age children with ID demonstrate:
progress in reading, writing, math, concepts of money and time lag behind compared to peers
adults with ID demonstrate:
academic skills at elementary level
support required for use of academic skills in work
assistance needed for conceptual tasks
diagnostic tools for Intellectual Disability
Denver developmental screening test (DDST)
Wechsler intelligence scale for children (WISC-V)
*severity based on adaptive functioning - not IQ!
global developmental delay
unable to undergo systematic assessments of intellectual functioning
meet dx criteria for ID
likely secondary to acquired insult or head injury during developmental period
language disorders
difficulty with spoken, written, and sign language
language abilities are below those expected for age and negatively impact functioning
difficulties are not due to hearing or sensory impairment, motor dysfunction, neuro condition or being a foreign language speaker
speech sound disorders
difficulty making speech sounds that are intelligible and limits verbal communication
interferes with social participation, academic achievement, and occupational performance
not due to congenital or acquired conditions such as CP, cleft palate, deafness, or TBI
no attributed to limited opportunity for language acquisition
Childhood-onset fluency disorder (stuttering)
difficulty with fluency and patterns of speech sound
limits effective communication, social participation and academics due to anxiety
not due to speech-motor or sensory deficit, neuro insult, or another mental disorder
social (pragmatic) communication disorder
difficulty with social use of verbal and nonverbal communication (ex: greetings, sharing info, social cues)
deficits may not become obvious until social communication demands exceed limited capacities
not due to other medical or neuro conditions.
not due to autism, ID, global delay or other language DO
autism spectrum disorder
problems with social communication and social interaction
problems with nonverbal behaviors used for social interaction
problems with developing, maintaining, and understanding relationships
restricted, repetitive patterns of behavior, interests or activities
insistence on sameness, inflexible adherence to routines, or ritualized patterns
obsessive and intense fixation with objects or subjects of interest
abnormal reaction to sensory input
how do you differentiate between ASD and ID?
presence of restricted interests or repetitive behaviors
behavioral interventions for ASD
education and support for parents, siblings, and teachers
learning about “parallel processing” for behavior
controlling the environment to limit sensory overload
allow for difficulty with transitions
FDA approved medications for irritability and agitation in ASD
risperidone
arirpiprazole
pediatric prevalence of ADD/ADHD
8.7% of children in the US between ages 8-15
boys > girls
girls with ADHD present with inattentive subtype, therefore, less likely to receive treatment
ADHD comorbidities
mood disorders anxiety disorders substance abuse intermittent explosive disorder tic disorders suicidality
Tourette’s syndrome triad
motor/vocal tics lasting > 1 yr (Tourette’s)
ADHD
OCD
executive functioning deficits in ADHD
ability to assess a situation
prioritizing relevant vs irrelevant
filtering extraneous information
developing and organizing a plan of action
execute the plan to completion
assess the effect of action in a fluid manner
what part of the brain is linked to executive functioning deficits in ADHD?
dorsal anterior midcingulate cortex
*primarily due to deficiency in DA and NE
which parts of the brain are linked to inhibition tasks in ADHD?
right inferior prefrontal cortex
supplemental motor area
anterior cingulate cortex
left caudate
which parts of the brain are linked to attention tasks in ADHD?
right dorsolateral prefrontal cortex left putamen and globus pallidus right posterior thalamus and caudate right inferior parietal lobe superior temporal lobe
inattentive type ADHD (6+ symptoms for dx)
failures to give close attention to details/makes careless mistakes
difficulty sustaining attention
does not appear to listen
struggles to follow through on instruction
difficulty with organization
avoids or dislikes tasks requiring a lot of thinking
loses things
easily distracted
forgetful in daily activities
hyperactive type ADHD (6+ sx for dx)
fidgets with hands or feet/squirms in chair
difficulty remaining seated
runs or climbs excessively
difficulty engaging in activities quietly
acts as if driven by a motor
talks excessively
blurts out answers before questions are completed
difficulty waiting or taking turns
ADHD diagnostic tools
Computerized:
TOVA
Conners continuous performance test
Checklist:
Vanderbilt
Conners
ADHD treatment for preschool-aged children (4-5 y/o)
- behavioral therapy
2. methylphenidate if behavioral therapy does not provide significant improvement
ADHD treatment for elementary school-aged children and older (6-18 y/o)
behavioral + pharmacological therapy
developmental coordination disorder
problems with coordinated motor skills
interferes with self-care and self-maintenance
interferes with school, vocational, leisure and play activities
not attributed to neuro condition such as CP, MD or degenerative DO
stereotypic movement disorder
repetitive, compulsive and purposeless motor behavior
not attributed to effects of a substance or neuro condition
not attributed to mental disorder - trichotillomania or OCD
criteria for Tourette’s disorder
multiple motor and phonic tics present
tics occur many times a day, every day for > 1 yr
location, frequency, type, and severity of tics changes
onset before age 18
movements/noises not explained by other medical condition
tics must be witnessed or recorded
Tourette’s comorbidities
ADHD OCD anxiety DOs mood DOs suicidality disruptive behaviors learning disabilities sleep DOs
Tourette’s medications
antidopaminergics dopamine depleters antipsychotics a adrenergic agonists botox anticonvulsants
Persistent motor or vocal tic disorder
single or multiple motor or vocal tics - do not occur together
persisted for > 1 yr
onset before age 18
not attributed to substance or other medical condition
have not met criteria for Tourette’s
