Clinical Approach to Neurodevelopmental and Attention Disorders Flashcards
What are some neurodevelopmental disorder?
- Intellectual disability
- Communication disorders
- Autism Spectrum Disorders
- Attention-Deficit/Hyperactivity Disorder
- Motor Disorders
When do neurodevelopmental disorders develop?
- Early in development
- For all motor disorders, must be present before the child enters grade school
What do neurodevelopmental disorders produce?
- Impairments of personal, social, academic, or occupational functioning
What is an intellectual disability?
- Will have adaptive functioning deficits in three domains: conceptual, social, and practical
What is a part of the conceptual domain in an intellectual disability?
- Reasoning
- Problem solving
- Planning
- Abstract thinking
- Judgement
- Academic learning
- Learning from experience
What is seen in preschoolers with an intellectual disability?
- Language and pre-academic skills develop slowly
What is seen in school age children with an intellectual disability?
- Progress in reading, writing, mathematics, concepts of time and money lags behind that of peers
What is seen in adults with an intellectual disabilty?
- Academic skill typically at an elementary level
- Support is required for all use of academic skills in work and personal life
- Assistance may be needed for conceptual tasks of day-to-day life
What is seen in the social domain in an intellectual disability?
- Difficulty developing age-mates, is immature in social interactions
- Difficulty accurately perceiving peers’ social cues
- Communication, conversation, and language are more concrete, less mature
- Difficulties regulating emotion and behavior are noticed by peers in social situations
- Social judgements is immature for age, the person is at risk of being manipulated by others
What is seen in the practical domain in an intellectual disability?
- Difficulty with age-appropriate personal care
- Adults need help with grocery shopping, transportation, home and child care, food preparation, and money management – support is typically needed to raise a family
- Difficulty making good decisions about personal well-being and recreational activities
- Competitive employment restricted to jobs that do not emphasize conceptual skills
- Need help making health care and legal decisions
What are some diagnostic tools if an intellectual disability?
- Denver Developmental Screening Test (DDST): covers gross motor, language, fine motor-adaptive, and personal-social
- Wechsler Intelligence Scale for Children (WISC-V): measures a child’s intellectual ability
What is severity based on in an intellectual disability?
- Adaptive functioning – NOT IQ
What is global developmental delay?
- Unable to undergo systemic assessments of intellectual functioning
- Meet observational diagnostic criteria of intellectual disability disorder
- Children who are too young to participate in standardized testing
- Acquired insult during the developmental period
- Severe head injury
What about language is affected in communication disorders?
- Conventional system of spoken words
- Sign language
- Written words
- Pictures
What about speech is affected in communication disorders?
- Articulation
- Fluency
- Voice
- Resonation quality
What about communication is affected in communication disorders?
- Verbal and nonverbal behavior that conveys thoughts and feelings
What is seen in language disorder?
- Difficulty with spoken, written, and sign language
- Reduced vocabulary
- Limited ability to form complete sentences
- Limited ability to connect sentences to explain things or have a conversation
- Language abilities are below those expected for agen and negatively impact functioning
- Difficulties are not due to hearing or sensory impairment, motor dysfunction, neurological condition, or due to being a foreign language speaker
What is seen in speech sound disorder?
- Difficulty making speech sounds that are intelligible and limits verbal communication
- Interferes with social participation, academic achievement, and occupational performance
- Not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical neurological conditions
- Not attributable to limited opportunity for language acquisitions
What is seen in Childhood-Onset Fluency Disorder (stuttering)?
- Difficulty with the fluency and patterns of speech sound
- Sound prolongations
- Pauses within a word
- Audible or silent pauses in speech
- Word substitutions to avoid problematic words
- Words pronounced with an excess of physical tension
- Monosyllabic whole-word repetitions
- Causes anxiety about speaking and limits effective communication, social participation, academic performance
- Not attributable to a speech-motor or sensory deficit, neurological insult such as stroke, tumor, or trauma, or other mental disorder
What is seen in Social (pragmatic) Communication Disorder?
- Difficulty with social use of verbal and nonverbal communication
- Such as greeting and sharing information as appropriate for the social setting
- Such as speaking differently in a classroom than on a playground, talking differently to a child than an adult, and avoiding overly formal language
- Such as taking turns in conversations, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals
- Difficulty understanding inferences, idioms, humor, metaphors, and things that have different meanings depending on the context
What is social communication disorder no attributable to?
- Another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability, global developmental delay, another mental disorder or language acquisition
What are the diagnostic features of social communication disorder?
- A primary difficulty with the social use of language
What are the associated features that support the diagnosis?
- Delay in reaching language milestones
What are the problems with social communication and social interaction across multiple contexts in autism spectrum disorder?
- Failure of normal back and forth conversation
- Reduced sharing of interests, emotions, or affect
- Failure to initiate or respond to social interactions
What are the problems with nonverbal behaviors used for social interaction in autism spectrum disorder?
- Poorly integrated verbal and nonverbal communication
- Lack of meaningful eye contact
- Limited use body language, gestures, or facial expressions
What are the problems with developing, maintaining, and understanding relationships in autism spectrum disorder?
- Adjusting behavior to suit various social contexts
- Sharing imaginative play or making friends (prefers parallel play versus interactive play)
- Absence of interest in peers
What are the restricted, repetitive patterns of behavior, interests, or activities in autism spectrum disorder?
- Repetitive motor movements
- Obsessively lining up toys or rearranging objects
- Echolalia
- Idiosyncratic phrases
What are some insistence on sameness, inflexible adherence to routines, or ritualized patterns in autism spectrum disorder?
- Extreme distress at small changes
- Difficulties with transitions
- Rigid thinking patterns
- Greeting rituals
- Need to take same route or eat same food every day
What are some obsessive and intense fascination or fixation with objects or subjects of interest in autism spectrum disorder?
- Strong attachment to or preoccupation with unusual objects
- Excessively circumscribed or perseverative with unusual objects
What are some abnormal reactions to sensory input in autism spectrum disorder?
- Either overreacts or under reacts
- Apparent indifference to pain/temperature
- Prone to sensory overload that can cause agitation and meltdowns
- Adverse response to specific sounds or textures
- Excessive smelling or touching of objects
- Visual fascination with lights or movement
What are the behavioral interventions in autism spectrum disorder?
- Education and support for parents, siblings, teachers, and caregivers
- Learning about “parallel process” and learning how to use it for behavioral management
- Controlling the environment to limit sensory overload
- Allow for difficulty with transitions
What are the only two meds that are used for the irritability and agitation associated with autism?
- Risperidone
- Aripiprazole
What do females with ADHD present with more often than males?
- Inattentive subtype
- BUT females have less disruptive behavior which may cause under identification and lack of treatment
What is the estimated prevalence of ADHD in adults?
- 4.4%
What is other comorbidities are significantly seen with ADHD?
- Psychiatric disorders like mood, anxiety, substance, intermittent explosive, and tic disorders
How can the susceptibility to tics be missed in ADHD?
- Tics may be subtle and may be absent during assessment for ADHD
- Potential for tics can be exacerbated by stimulant medications used to treat ADHD
What is the Tourette’s syndrome triad?
- Childhood onset of multiple motor and vocal tics lasting more than one year
- Symptoms of ADHD and OCS are present in most Tourette’s patients and constitutes a Tourette’s Syndrome Neuropsychiatric Spectrum
How is ADHD linked to childhood suicide?
- Among suicide decedents with known mental health problems, childhood decedents more often experienced ADHD and less often experienced depression/dysthymia compared with early adolescent decedents
What are some executive function deficits that are associated with ADHD?
- Ability to assess a situation
- Prioritizing what is relevant vs irrelevant
- Filtering out extraneous information
- Developing and organizing a plan of action
- Execute the plan to completion
- Assess effect of action in a fluid mannar
What is the primary deficiency of executive function deficits?
- Deficiency of dopamine and norepinephrine
What are inhibition tasks?
- Regions of decreased activation in areas such as:
1. The right inferior prefrontal cortex extending into the insula
2. A cluster comprising the supplementary motor area (SMA)
3. Cognitive division of anterior cingulate cortex
4. Left caudate extending into the putamen and insula, and in the right mid-thalamus
What are attentions tasks?
- Regions of decreased activation in areas such as:
1. Right dorsolateral prefrontal cortex
2. Left putamen and globus pallidus
3. Right posterior thalamus and caudate tail extending into the posterior insula
4. Right inferior parietal lobe
5. Precuneus and superior temporal lobe - Regions of increased activity in areas such as:
1. Left cuneus
2. Right cerebellum
What was used when looking at the brain of those with executive function deficits?
- Multimodal MR imaging
In making the diagnosis of ADHD, how many symptoms should a child have?
- Six or more
In making the diagnosis of ADHD, how many symptoms should a adult have?
- At least 5
What is the inattentive type of ADHD?
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Has difficulty with organization
- Avoids or dislikes task requiring a lot of thinking
- Loses things
- Is easily distracted
- Is forgetful in daily activities
What is the hyperactive type of ADHD?
- Fidgets with hands or feet or squirms in chair
- Has difficulty remaining seated
- Runs about or climbs excessively in children; extreme restlessness in adults
- Difficulty engaging in activities quietly
- Acts as if driven by a motor; adults will often feel inside like they were driven by a motor
- Talks excessively
- Blurts out answer before questions have been completed
- Difficulty waiting or taking turns
What are some diagnostic tools for ADHD?
- Computerized tests like TOVA and Conners Continuous Performance Test
- Standardized checklists like Vanderbilt and Conners
What is the first line therapy for preschool aged children?
- Prescribe evidence-based parent (and/or teacher) administered behavior therapy
What is second line therapy for preschool aged children with ADHD?
- Prescribe methylphenidate if behavior therapy does not provide significant improvement and the child continues to have moderate to severe symptoms
What is the first line therapy for elementary school-aged children with ADHD?
- Prescribe FDA approved medications for ADHD and/or evidence-based parent and/or teacher administered behavior therapy as treatment for ADHD, although preferably both medication and behavior therapy should be used together
What is the first line therapy for adolescents with ADHD?
- Prescribe FDA approved medications for ADHD with the consent of the adolescent
- And may prescribe behavior therapy as treatment for ADHD, although preferably both medication and behavior therapy should be used together
What are some problems with coordinated motor skills?
- Clumsiness (dropping or bumping into objects)
- Catching an object
- Using scissors or cutlery
- Handwriting
- Riding a bike
- Participating in sports
How do developmental coordination disorders affect people?
- Interferes with self-care and self-maintenance
- Interferes with school, vocational, leisure, and play activities
What is developmental coordination disorders not attributable to?
- A neurological condition such as cerebral palsy, muscular dystrophy, or other degenerative disorder
What is a part of stereotypic movement disorder?
- Repetitive, compulsive, and purposeless motor behavior
- Interferes with social, academic, or other activities that may result in self-injury
What consists of repetitive, compulsive, and purposeless behavior seen in stereotypic movement disorder?
- Hand shaking or waving
- Body rocking
- Head banging
- Self-biting
- Hitting own body
What is stereotypic movement disorder not attributable with?
- Effects of a substance or neurological condition, another neurodevelopmental or mental disorder (trichotillomania or OCD)
What is a tic disorder?
- A sudden, rapid, recurrent, nonrhythmic motor movement or vocalization
What is must be present for Tourette’s disorder?
- Both multiple motor tics and one or more phonic tics at some time during the illness, although not necessarily concurrently
- Tics must occur many times a day, nearly every day, or intermittently throughout a period of more than one year
What must change over time in Tourette’s disorder?
- Anatomical location, number, frequency, type, complexity or severity of tics
When does Tourette’s disorder need to be seen?
- Before 18 year olds
What are some comorbidities seen in Tourette’s disorder?
- ADHD
- OCD
- Anxiety disorders
- Mood disorders and risk of suicide
- Disruptive behaviors
- Learning disabilities and poor school performance
- Sleep disorders
What are some medications that are used in Tourette’s disorder?
- Antidopaminergic drugs
- Dopamine depleters
- Antipsychotics
- Alpha adrenergic agonists
- Botulinum toxin injection
- Anticonvulsants
What is persistent motor or vocal tic disorder?
- Single or multiple motor or vocal tics have been present during the illness but not both
- Tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
- Onset is before age 18 years
- Not attributable to the physiological effects of a substance or other medical condition
