CM: Child Psych 1

Question 1

What is the definition of intellectual disability (ID)?

Answer 1

deficits in intellectual or adaptive functioning
onset during developmental period
severity based on adaptive functioning which determines level of support needed, not IQ score

Question 2

What are important features of MILD intellectual disability?

Answer 2

preschool age may show no obvious differences
speech grossly similar to peers
personal care intact
needs some support for complex skills/decisions
jobs are possible

Question 3

What are important features of MODERATE intellectual disability?

Answer 3

conceptual deficits present throughout life
can perform personal care by adulthood but may need reminders and teaching
jobs still possible

Question 4

What are important features of SEVERE intellectual disability?

Answer 4

speech generally single words or phrases

requires supervision at all times

Question 5

What are important features of PROFOUND intellectual disability?

Answer 5

little to no speech

requires supervision at all times

Question 6

What is the epidemiology of ID?

Answer 6

males affected slightly more often than women

mild&raquo_space;»» severe

Question 7

What is the etiology of ID?

Answer 7

genetic: Downs, fragile X, fetal alcohol, others
prenatal: inf and toxins (TORCH)
perinatal: anoxia, prematurity, birth trauma
Postnatal: hypoT, malnutrition, encephalitis/sepsis, trauma, lead poisoning

Question 8

What are risk factors for ID of unknown etiology?

Answer 8

low birth weight
lower maternal education, Asian or Hispanic moms - risk for severe ID
lower SES, multiple births, second or later born - risk for mild

Question 9

What are some important clinical issues in ID?

Answer 9

psychiatric conditions often missed: attributed to ID
careful eval for underlying medical illness or pain must be conducted
common foci of treatment: self-injury, aggression, hyperactivity/impulsivity, stereotypies (rocking, flapping)
higher risk of adverse med rxns
caregiver burn-out

Question 10

What is the treatment for ID?

Answer 10

educational settings w programs addressing adaptive and social skills training, vocational training, behavioral therapy, etc
family education
pharm to address aggression, self injury, comorbidities, stereotypies (risperidone used a lot)

Question 11

What is the IDEA?

Answer 11

guarantees right of students w disabilities to free, appropriate, public education - ppl b/w 3-21 years old
anyone can request eval - must happen w/i 60 days
services deemed necessary incorporated into IEP unique for student

Question 12

What is the definition of global developmental delay?

Answer 12

children under 5 yrs of age who fail to meet expected developmental milestones in several areas of intellectual fxning and are unable to undergo assessment of intellectual fxning (too young)
requires future reassessment

Question 13

What is unspecified intellectual disability?

Answer 13

individuals over 5 yrs of age w intellectual disabilities but cannot be assessed because of physical or sensory impairments or comorbid disorders
requires future reassessment

Question 14

What is the diagnostic evaluation of children with ID?

Answer 14

screening by PCP –> specialty eval (H&P, fxnal testing, lead screening) –> genetic testing (CMA is standard for unexplained ID), brain imaging, EEG, metabolic testing

Question 15

What is specific learning disorder?

Answer 15

difficulties acquiring and using academic skills appropriate for age and grade
specify: w impairment in reading, written expression, or math
symptoms for at least 6 mos, despite interventions
not accounted for by IDs, lack of education, or another disorder

Question 16

What is the epidemiology of learning disorders?

Answer 16

more common in males than females

Question 17

What is the etiology of learning disorders?

Answer 17

genetic, perinatal injury (prematurity, low birth weight, maternal exposure), neurological/medical conditions
presentation affected by environmental factors and personal factors

Question 18

What are some important clinical issues in regards to learning disorders?

Answer 18

can lead to poor self esteem, low morale, poor relationships
more likely to drop out of school (rates of 40%), problems w employment and social adjustment
common comorbids = depression, ADHD, disruptive behavior disorders

Question 19

How are learning disorders evaluated for diagnosis?

Answer 19

hx of learning problem and performance on standardized or psychometric measures
assessment of outside impairments on learning
info from multiple sources

Question 20

What is the treatment of learning disorders?

Answer 20

and IEP, management of comorbids

Question 21

What are the two symptoms domains of autism spectrum disorders?

Answer 21

social communication impairment
restricted interests/repetitive behaviors
must be present in early dev period and affect fxning

Question 22

How is social communication impairment manifested in children w autism?

Answer 22

must have deficits in all 3 of the following (currently or by hx): social-emotional reciprocity, nonverbal communicative behaviors for social interxn, developing or maintaining and understanding relationships

Question 23

How is the restricted, repetitive behavior pattern manifested in children with autism?

Answer 23

at least 2 of the following (currently or by hx): stereotyped or repetitive movements, insistence on sameness or ritualized behavior patterns/routines, highly fixated and restricted interests, inc or dec response to sensory input or unusual interest in sensory aspects of environment

Question 24

What is the epidemiology of autism spectrum disorders?

Answer 24

prevalence increasing: increased awareness, changes in definition, actual increase from unknown etiology
boys 5x more than girls
up to 20% siblings affected

Question 25

What is the etiology of autism spectrum disorders?

Answer 25

interxns b/w multiple genes, w exposure to environmental modifiers
genetic factors (advanced paternal age), prenatal neurological insults, metabolic or mitochondrial disorders (rare)

Question 26

What are important clinical issues of autism spectrum disorders?

Answer 26

40-60% have ID
sleep disorders, seizures (in more severe ID), GI issues (restricted diet –> constipation or malnutrition), social isolation, comorbids = anxiety, ADHD, associated w tuberous sclerosis and fragile X, higher risk of behavioral response to meds
common behavioral problems: sensory issues, self-injury, aggression, hyperactivity/impulsivity, sleep disorders

Question 27

What is the treatment for autism spectrum disorders?

Answer 27

tailored to individual: IEP, physical/occupational/behavrioal/sensory integration/social skills therapy, support groups
meds - only if needed (risperidone or abilify for agression and self harm, stimulants/alpha2 agonists/antipsychotics for hyperactivity, SSRIs for repetitive behaviors (fluoxetine) or anxiety)

Question 28

What is applied behavioral analysis (ABA)?

Answer 28

behavioral therapy including discrete trial training - based on operant conditioning (parents = co-therapists)
can teach social and adaptive behaviors and decrease problem behaviors
most evidence of efficacy in autism spectrum disorders

Question 29

What is the prognosis for children with autism spectrum disorders?

Answer 29

if no associated medical disorder - normal lifespan
variable fxnal outcome, but all will have some social difficulty
those w Aspergers or normal IQ can develop expertise in limited area and become successful
most significant predictors of outcome = cognitive level and language abilities

Question 30

What is social (pragmatic) communication disorder?

Answer 30

difficulties in social use of verbal and nonverbal communication: difficulty using communication for social purposes, following rules for conversation/story telling, understanding things not explicitly stated
onset in early dev period

Question 31

How can social communication disorder be differentiated from autism spectrum disorders?

Answer 31

no restricted/repetitive patterns of behavior or interests