Developmental Coord. Disorder + Stereotypic Mvmt Disorder

Question 1

how many criteria are there for developmental coordination disorder

Answer 1

4 (a,b,c,d)

Question 2

what is criterion A for developmental coordination disorder

Answer 2

the acquisition and execution of coordinated motor skills is substantially below that expected given the individuals chronological age and opportunity for skill learning and use.

difficulties are manifested as CLUMSINESS (dropping or bumping into objects), as well as SLOWNESS and INACCURACY of performance of motor skills (i.e catching an object, using scissors or cutlery, handwriting, riding a bike, participating in sports)

Question 3

what is criterion B for developmental coordination disorder

Answer 3

the motor skills deficit in criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (i.e self care and self maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure and play

Question 4

what is criterion C for developmental coordination disorder

Answer 4

onset of symptoms is in the early developmental period

Question 5

what is criterion D for developmental coordination disorder

Answer 5

the motor skills deficits are not better explained by intellectual disability or visual impairment and not not attributable due to a neurological condition affecting movement

Question 6

how might developmental coordination disorder manifest in young children

Answer 6

delays in achieving motor milestones (i.e sitting, drawing, walking) –> BUT many achieve typical motor milestones

may be delayed in developing skills such as negotiating stairs, pedaling, buttoning shirts, completing puzzles, using zippers (even when this skill is achieved, movement execution may appear awkward, slow or less precise than peers)

Question 7

how might developmental coordination disorder manifest in older children and adults

Answer 7

may display slow speed or inaccuracy with motor aspects of activities such as assembling puzzles, building models, playing ball games (especially in teams), handwriting, typing, driving or carrying out self care

Question 8

developmental coordination disorder is typically not diagnosed until AFTER what age?

Answer 8

not usually diagnosed until after age 5 because there is considerable variation in the age at acquisition of many motor skills or a lack of stability of measurement in early childhood i.e some kids catch up

also other causes of motor delay may not have fully manifested before age 5

Question 9

what other examinations are required in the assessment of developmental coordination disorder

Answer 9

visual function exam

neurological exam

Question 10

can intellectual disability be diagnosed alongside developmental coordination disorder

Answer 10

yes, but if intellectual disability is present, the motor difficulties must be in excess of those expected for the mental age (but there is no IQ cut off)

Question 11

does developmental coordination disorder have discrete subtypes

Answer 11

no–> but individuals may be impaired predominantly in gross motor skills or in fine motor skills including handwriting skills

Question 12

what are other motor signs that may support the diagnosis of developmental coordination disorder

Answer 12

some kids with developmental coordination disorder may have additional (usually suppressed) motor activity–> choreiform movement of unsupported limbs or mirror movements

–> called neurodevelopmental immaturities or neurological soft signs

Question 13

what is the prevalence of developmental coordination disorder

Answer 13

ages 5-11–> 5-6%

Question 14

which gender is more affected by developmental coordination disorder and in what ratio

Answer 14

males more than females

between 2:1 and 7:1

Question 15

what is the natural course of developmental coordination disorder

Answer 15

course is variable but stable to at least 1 year follow up

may be improvement in long term but problems with coordinated movements continue through teen years in about 50-70% of kids

Question 16

what environmental factors increase risk for developmental coordination disorder

Answer 16

prenatal exposure to alcohol

preterm and low birth weight infants

Question 17

what neurodevelopmental processes show impairment in those with developmental coordination disorder

Answer 17

impairments in visual motor skills–both in visual-motor perception and spatial mentalizing

Question 18

what other psychiatric condition does developmental coordination disorder exacerbate

Answer 18

those with ADHD + developmental coordination disorder show more impairment than those with ADHD without developmental coordination disorder

Question 19

list some functional consequences of developmental coordination disorder

Answer 19

1. reduced participation in team play and sports
2. poor self esteem and sense of self worth
3. emotional or behaviour problems
4. impaired academic achievement
5. poor physical fitness
6. reduced physical activity and obesity

Question 20

ddx for developmental coordination disorder

Answer 20

1. motor impairments due to another medical condition
2. intellectual disability
3. ADHD
4. autism
5. joint hypermobility syndrome

Question 21

how do you distinguish between developmental coordination disorder and ADHD

Answer 21

observe across contexts to see if lack of motor competence is attributable to distactibility/impulsiveness or to developmental coordination disorder

Question 22

what disorders commonly co occur with developmental coordination disorder

Answer 22

speech and language disorder

specific learning disorder (especially reading and writing)

problems of inattention, including ADHD

ASD

disruptive and emotional behavior problems

joint hypermobility syndrome

Question 23

what is the most frequently comorbid condition with developmental coordination disorder

Answer 23

ADHD–> 50% co-occurrence

Question 24

how many criteria are there for stereotypic movement disorder

Answer 24

4

Question 25

what is criteria A for stereotypic movement disorder

Answer 25

repetitive, seemingly driven, and apparently purposeless motor behavior (i.e hand shaking or waving, body rocking, head banging, self biting, hitting own body)

Question 26

what is criterion B for stereotypic movement disorder

Answer 26

the repetitive behavior interferes with the social, academic or other activities and may result in self injury

Question 27

what is criterion C for stereotypic movement disorder

Answer 27

onset is in the early developmental period

Question 28

what is criterion D for stereotypic movement disorder

Answer 28

the repetitive motor behaviour is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder (i.e trichotillomania, OCD)

Question 29

what are the specifiers for stereotypic movement disorder

Answer 29

1. specify if with, or without, self injurious behaviour
2. specify if associated with a known medical or genetic condition, neurodevelopmental disorder, or environmental factor (i.e Lesch-Nyhan syndrome, intellectual disability, intrauterine alcohol exposure)

Question 30

define stereotypic movement disorder of MILD severity

Answer 30

symptoms are easily suppressed by sensory stimulus or distraction

Question 31

define stereotypic movement disorder of MODERATE intensity

Answer 31

symptoms require explicit protective measures and behavioural modification

Question 32

define stereotypic movement disorder of SEVERE intensity

Answer 32

continuous monitoring and protective measures are required to prevent serious injury

Question 33

describe features of the movements often associated with stereotypic movement disorder

Answer 33

often rhythmical movements of head, hands or body without obvious adaptive function

however, each kid typically presents with their own individually patterned, “signature” behaviour

Question 34

do the movements of stereotypic movement disorder reliably respond to efforts to stop them

Answer 34

they may or may not respond to efforts to stop them

Question 35

in which types of children are the movements often reliably suppressed by drawing the child’s attention to it, or by distraction?

Answer 35

in typically developing children, these techniques often work

in kids with neurodevleopmental disorders, behaviours are typically less responsive to efforts at suppression

Question 36

list some examples of non self injurious stereotypic behaviours

Answer 36

body rocking

bilateral flapping or rotating hand movements

flicking or fluttering fingers in front of face

arm waving or flapping

head nodding

Question 37

list some examples of self injurious stereotypic behaviours

Answer 37

head banging

face slapping

eye poking–> particularly concerning

biting of hands, lips, other body parts

Question 38

in which children does eye poking as a stereotypic movement more frequently occur

Answer 38

kids with visual impairment

Question 39

how long do the stereotypic movements last

Answer 39

can occur many times during a day and may last a FEW SECONDS to SEVERAL MINUTES or longer

Question 40

are stereotypic movements always pathologic?

Answer 40

no–> some simple stereotypic movements are common in infancy–> may be involved in acquisition of motor mastery

however, in typically developing children, these movements resolve over time or can be suppressed

Question 41

at what age do symptoms typically present, in those kids that develop complex motor stereotypies

Answer 41

80% show symptoms before age 24 months

12% between 24-35 months

8% at 36 months or thereafter

Question 42

list environmental risk factors for developing stereotypic movement disorder

Answer 42

social isolation –> risk factor for self stimulation which. may progress to stereotypic movements with repetitive self injury

environmental stress can trigger stereotypic behaviour (and fear can increase frequency of behaviours due to altered physiological state)

Question 43

list genetic and physiological risk factors for stereotypic movement disorder

Answer 43

lower cognitive function (also linked with poorer response to interventions)
–> more frequent among those with moderate to severe/profound intellectual disability

may be a behavioral phenotype in neurogenetic syndromes (i.e Lesch-Nyhan)

Question 44

name five genetic conditions associated with stereotypic movements

Answer 44

Lesch-Nyhan syndrome

Rett syndrome

Cornelia de Lange syndrome

fragile X syndrome

Smith-Magenis syndrome

Question 45

what stereotypic movements are associated with Lesch-Nyhan syndrome

Answer 45

both stereotypic dystonic movements and self mutilation of fingers, lip biting and other forms of self injury unless patient restrained

Question 46

what stereotypic movements are associated with Rett syndrome and Cornelia de Lange syndrome

Answer 46

hand to mouth stereotypies

Question 47

ddx for stereotypic movement disorder

Answer 47

1. normal development
2. ASD
3. tic disorders
4. OCD and related disorders
5. other neuro and medical conditions

Question 48

stereotypic movements may be a presenting symptom of what disorder

Answer 48

ASD

ASD should be considered when repetitive movements and behaviours are being evaluated

Question 49

how to distinguish between ASD and stereotypic movement disorder

Answer 49

deficits in social communication and reciprocity that characterize autism are generally absent from stereotypic movement disorder

*when ASD is present, stereotypic movement disorder is usually only diagnosed if/when there is self injury present or when the movements are sufficiently severe to become a focus of treatment

Question 50

how do tics and stereotypic movement disorders differ in terms of age of onset

Answer 50

stereotypic movement disorder has EARLIER onset (before age 3), whereas mean age at onset of tics is 5-7 years

Question 51

how do tics and stereotypic movement disorders differ in terms of pattern/quality

Answer 51

stereotypic movement disorder movements are fixed in pattern or topography; may involve arms, hands, or entire body

tics are variable in their presentation; also tend to involve head, face, eyes, and shoulders

Question 52

how do tics and stereotypic movement disorders differ in terms of timing

Answer 52

stereotypic movement disorder behaviours are more FIXED, RHYTHMIC and PROLONGED in duration

tics are generally BRIEF, RAPID, RANDOM and FLUCTUATING

Question 53

how are tics and stereotypic movements similar

Answer 53

both reduced by distraction

Question 54

how do you distinguish OCD from stereotypic movement disorder

Answer 54

by the absence of obsessions

Question 55

what distinguishes trichotillomania/excoriation disorders from stereotypic movement disorder

Answer 55

nature of movements and age of onset

stereotypic movement disorder–> onset before age 3

trichotillomania/excoriation–> around puberty typically

Question 56

what must be ruled out when assessing stereotypic movement disorder

Answer 56

habits

mannerisms

paroxysmal dyskinesias

benign hereditary chorea

myoclonus