[CLMD CIS] Clinical Approach to Neurodevelopmental and Attention Disorders [Cooley] Flashcards
What is a neurodevelopmental disorder?
Typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce iimpairments of:
- Personal
- Social
- Academic
- Occupational functioning
What are the (5) major categories of neurodevelopmental disorders?
Intellectual disability
Communication disorders
Autism spectrum disorder
Attention-deficit/Hyperactivity disorder
Motor disorders
What are the characteristic deficits of intellectual disability?
Deficits in:
- Reasoning
- Problem solving
- Planning
- Abstract thinking
- Judgement
- Academic learning
- Learning from experience
An intellectual disability can cause a secondary impairment of ________________
An intellectual disability can cause a secondary impairment of ADAPTIVE FUNCTIONING
Adaptive functioning = Communication, social participation, academic/occupational functioning, personal independence at home or in community settings
What is the global developmental delay diagnosis used for?
Individuals who are unable to undergo systematic assessments of intellectual functioning
- Too young
- Severe head injury
What are the three criteria that must be met to diagnose an intellectual disability?
- Deficits in intellectual functions
- Deficits in adaptive functioning
- Onset of intellectual and adaptive deficits during the developmental period
Adaptive functioning deficits have 3 specific domains that you will rate from Mild-Moderate-Severe-Profound.
What are those 3 domains?
Conceptual domain
Social domain
Practical domain
What are examples of criteria that fall under the conceptual domain of adaptive functioning deficits?
Language/pre-academic skills develop slowly
Reading, writing, mathematics and understanding of time and money lags behind peers
For adults: ongoing assistance needed for conceptual tasks of day-to-day life
What are examples of criteria that fall under the social domain of adaptive functioning deficits?
Immature in social interactions
Difficulty perceiving peer’s social cues
Social judgement is immature for age
Gullibility
What are examples of criteria that fall under the practical domain of adaptive functioning deficits?
Difficulty w/ age-appropriate personal care
Difficulty with complex daily living tasks in comparison to peers
What are examples of communication disorders?
Speech sound disorder
Social (pragmatic) communication disorder
Childhood-onset fluency disorder (stuttering)
What are the differences b/w speech, language and communication?
Speech = Production of sounds
Language = Use of conventional system of symbols
Communication = Includes any verbal or non verbal behavior that influences the behavior, ideas or attitudes of another individual
Assessments of speech, language and communication abilities must take into account the individual’s ____________________
Assessments of speech, language and communication abilities must take into account the individual’s cultural and language context
What are the specific characteristics of language disorder?
- Persistent difficulties in the acquisition and use of language across modalities (spoken, written, sign language etc…)
- Reduced vocabulary
- Limited sentence structure
- Impairments in discourse
- Difficulties are not attributable to hearing/other sensory impairment
What are the specific characteristics of speech sound disorder?
- Persistent difficulty with speech sound production
- Limitations in effective communication
- These difficulties are not attributable to congenital or acquired conditions
What are the specific characteristics of childhood-onset fluency disorder (stuttering)?
- Disturbances in the normal fluency
- Sound and syllable repetitions
- Broken words
- Silent blocking
- Monosyllabic whole word repetitions (eg “I-I-I-I see him”)
- Not attributable to a speech-motor or sensory deficit
What are the specific characteristics of social (pragmatic) communication disorder?
- Persistent difficulty in the social use of verbal/non verbal communication
- Deficits in using communication for social purposes
- Impairment in ability to change communication to match context
- Difficulties understanding what is not explicitly stated
What are the specific characteristics of autism spectrum disorder?
- Persistent deficits in social communication and social interaction across multiple contexts
- Restricted repetitive patterns of behavior, interests or activities
- Significant impairment in social, occupational or other areas of current functioning
What is the best idication that a child has autism spectrum disorder and not intellectual disability?
RESTRICTED INTERESTS or REPETITIVE BEHAVIORS
What are the differences between level 1/2/3 for autism spectrum disorder classifications?
[least severe] Level 1 = Requiring support
Level 2 = Requiring substantial support
[most severe] Level 3 = Requiring very substantial support
What is one of the most consistently useful behavioral intervention for autism spectrum disorder?
Education and support for parents, siblings, teachers and caregivers
What is an effective method to become more cohesive with an autistic patient?
Parallel process
Interpreting what the autistic patient is doing and try to mirror the behavior; a form of reflecting to acheive the same level of interaction
What are the only 2 medications that are FDA approved for treating autism spectrum disorder?
Risperidone
Aripiprazole
What is tourette’s syndrome triad?
Childhood onset of multiple motor and vocal tics lasting more than one year
Tics, attention deficit hyperactivity disorder (ADHD) and obessive compulsive symptoms are comorbid in the majority of TS patients, this is the “TS clinical triad”
What is executive functioning?
Ability to assess a situation and prioritze what is relevant vs irrelevant
Where do executive functioning disorders originate in the brain?
Prefrontal cortex
Where is the most significant region of the cortex related to ADHD?
Dorsal anterior midcingulate cortex
What are the two types of of attention deficit disorder?
Inattentive type
Hyperactive type
What are the diagnostic tools to use for ADHD?
TOVA : Test of Variables of Attention
Conners continuous performance test
American Academy of Pediatrics(AAP) Clinical Practice Guidelines
For preschool aged children (4-5 y/o), what is the first line treatment for ADHD?
What if that doesn’t work?
Prescribe evidence based parent and/or teacher administered behavior therapy
Prescribe methylphenidate
American Academy of Pediatrics(AAP) Clinical Practice Guidelines
For elementary aged children (6-11 y/o), what is the first line treatment for ADHD?
Prescribe FDA approved medications for ADHD and/or behavior therapy
American Academy of Pediatrics(AAP) Clinical Practice Guidelines
For adolescents (12-18 y/o), what is the first line treatment for ADHD?
Prescribe FDA approved medications for ADHD with the assent of the adolescent
Also preferably add on behavioral therapy on top of the meds
What is an excellent alternative for ADHD treatment that is a NON stimulant?
Alpha 2 agonists
(Guanfacine, Clonidine)
What medication can be used to treat ADHD but should NOT be give to pts with seizure hx?
Bupropion
What drug inhibits presynaptic NE uptake and has the cholinergic side effects of (dry mouth, insomnia, nausea) and is used to treat ADHD?
Atomoxetine
What ADHD drug is indicated for ADULTS ONLY?!
Modafinil
What is the most highly prescribed ADHD medication that is at risk of being abused by non-ADHD patients?
Methylphenidate
What are the (3) major types of motor disorders?
Developmental coordination disorder
Stereotypic movement disorder
Tic disorders
What is developmental coordination disorder?
The acquisition and execution of coordinated motor skills is substantially below that expected at that age
Manifested as clumsiness
What is stereotypic movement disorder?
Repetitive, seemingly driven and apparently purposeless motor behavior
The behavior intereres with social, academic and other activities
What must you specify in a stereotypic movement disorder upon diagnosis?
Specify if:
- With self-injurious behavior
- Without self-injurious behavior
- Associated w/ a known medical/genetic condition
AND SEVERITY:
- Mild
- Moderate
- Severe
What is a tic disorder?
A tic is a sudden, rapid, recurrent non rhythmic motor movement or vocalization
What is the diagnostic criteria for tourette’s disorder?
Both multiple motor tics and one or more phonic tics must be present at some time during the illness, although not necessarily concurrently
What are some comorbidities associated with tourette’s?
ADHD
OCD
Anxiety disorders
Mood disorders
Suicide risk
Disruptive behaviors
Learning disabilities
Sleep disorders
What medications are used for tourette’s?
Antidopaminergic drugs
Antipsychotics
Dopamine depleters
Botox injections
Anticonvulsants
What is persistent (chronic) motor or vocal tic disorders?
Single or multiple motor or vocal tics have been present during the illness, but NOT BOTH MOTOR AND VOCAL
