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Block 8 week 3 > Developmental disorders - Ryst > Flashcards

Developmental disorders - Ryst Flashcards

1
Q

What is the average age for diagnosis of autism spectrum disorder?

A

Between ages 4 and 5. The earlier the better so that early intervention can start.

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2
Q

List some developmental disorders.

A
  1. learning disorders
  2. intellectual disability
  3. communication disorders
  4. Social pragmatic communication disorder
  5. autism spectrum disorders
  6. motor disorders
  7. global developmental delay
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3
Q

What are some communication disorders?

A
  1. Language disorder
  2. speech sound disorder
  3. childhood-onset fluency disorder (stuttering)
  4. Social pragmatic communication disorder
  5. unspecified communication disorder
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4
Q

Language disorder used to be classified how? How has it changed?

A

It used to be classified as subtypes of Expressive and Mixed expressive receptive. Expressive disorders have to do with producing speech and receptive with understanding speech. Usually language disorders are a mix so now in DSMV both subtypes are bunched together and called Language disorder.

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5
Q

According to the American Speech Language Hearing Association (ASLHA) what is a communication disorder?

A

Impairment in the ability to receive, send, process and comprehend concepts or symbol systems (such as language).

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6
Q

According to ASLHA what is a speech disorder?

A

Problems with articulation, fluency and voice.

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7
Q

According to ASLHA what is a language disorder?

A

Impaired comprehension and/or use of spoken, written or other symbol systems.

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8
Q

DSMV defines language disorder as?

A

Persisten difficulties in the acquisition and use of language across modalities due to deficits in comprehension or production that include the following:

  1. reduced vocabulary
  2. limited sentence structure
  3. impairments in discourse (verbal interaction/conversation)
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9
Q

DSMV defines Speech sound disorder as?

A

Persisten difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages.

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10
Q

DSMV defines Child-onset fluency disorder as?

A

Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, persists over time and are characterized by frequent or marked occurrences of one or more of the following:

  1. Sound and syllable repetitions
  2. sound prolongation of consonants and vowels
  3. broken words - pauses within words
  4. audible or silent blockers - filled or unfilled pauses in speech
  5. circumlocutions
  6. words produced with an excess of physical tension
  7. monosyllable whole word repetitions
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11
Q

What is circumlocutions?

A

In a person who stutters - avoidance of a word that is hard to pronounce.

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12
Q

Expressive language delay occurs in what percentage of children?

A
  1. 10-15% of children under 3 years of age

2. by school age this number goes down to only 3-7%

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13
Q

Language disorder occurs in what percentage of children?

A
  1. 5% of preschoolers

2. 3% of school age children

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14
Q

Phonological disorders occurs in what percentage of children?

A

Moderate to severe - occurs in 2% of early school-age children and up to 20% for the mild form.

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15
Q

Stuttering occurs in what percentage of young children?

A

1%

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16
Q

Communication disorder prevalence seems to decrease as kids get to be school age - why?

A

One reason is early intervention programs help reduce incidence and also some kids have a natural resolution without need for intervention.

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17
Q

What is the associated between communication disorders and psychiatric disorders in children?

A

About 1/2 of children with communication disorders have a psychiatric disorder also. It is not improbable to think that if the brain ‘wiring’ developed wrong and created a communication disorder then other systems may be affected also.

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18
Q

What are the most common comorbid psychiatric disorders associated with communication disorders?

A
  1. ADHD
  2. ODD
  3. conduct disorders
  4. anxiety disorders
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19
Q

If a child has a communication disorder what might be on our differential diagnosis?

A
  1. hearing impairment
  2. intellectual disability - occurs with delayed development in general
  3. Autism
  4. Selective mutism - has skills to speak but chooses not to
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20
Q

What is the general treatment plan for communication disorders?

A
  1. teach specific strategies to change the deficit and increases skills - speech and language therapy
  2. teach compensatory coping strategies
  3. change the child’s environment
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21
Q

What is the biggest asset in helping to improve a child’s development?

A

Involvement of the parents.

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22
Q

What is Hanen?

A

An evidence based program that teaches parents some therapy skills they can use to help their kids.

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23
Q

What are some motor disorders?

A
  1. Developmental coordination disorder
  2. Tic disorders
  3. Stereotypic movement disorders
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24
Q

Describe developmental coordination disorder.

A
  1. Acquisition and execution of coordinated motor skills is substantially below expected; difficulties are manifested as clumsiness, as well as slowness and inaccuracy of performance of motor skills.
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25
Q

What are some other criteria that need to be met before developmental coordination disorder can be diagnosed?

A
  1. must significantly interfere with academic achievement or activities of daily living
  2. must not be due to a medical condition and not be part of PDD (pervasive developmental delay)
  3. If intellectual disability is present, the motor difficulties must not be better explained by it (general developmental delay often accompanies intellectual disability)
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26
Q

What is often part of treatment for developmental coordination disorder?

A

Physical or occupational therapy.

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27
Q

What is the definition of a Tic?

A

Sudden, repetitive muscular contractions and vocalizations.

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28
Q

Describe some characteristics of a tic.

A
  1. last less than one second
  2. are voluntary - person can control to an extent but if try to suppress for too long then becomes involuntary
  3. tend to occur in bouts and wax and wane
  4. over time, they show rostral to caudal progression - ie. start with eye blinking and move down the body
  5. typical age of onset is 5-6 with peak intensity at 10-12 and tic reduction by 15-17 years
29
Q

What are simple tics?

A
  1. limited to few muscle groups
  2. eye blinking
  3. jaw thrusting
  4. throat clearing
30
Q

What are complex tics?

A

Multiple, organized contractions which mimic contexual speech or movement. Examples are:

  1. copropraxia - involuntarily performs obscene or forbidden gestures
  2. coprolalia - involuntary yelling out obscene words
  3. echolalia - involuntary repetition of another’s words
  4. echopraxia - involuntary imitation of another’s actions
31
Q

Do Tic disorders often resolve on their own?

A

Yes.

32
Q

What is a provisional tic disorder?

A

Motor or vocal tic that has been present for less than one year.

33
Q

What is chronic/persistent Tic disorder?

A

Motor or vocal tic that has been present for more than a year.

34
Q

What is Tourette’s disorder?

A

Includes multiple motor and one one or more vocal tics present at the same time during the illness. Tics may wax and wane in frequency but have persisted for more than one year since onset.

35
Q

What percentage of the population suffers from Tourette’s?

A

0.1%

36
Q

What percentage of chronic tic disorders affect school age children?

A

2-15%

37
Q

What is the overall prevalence of all tics (including transient)?

A

11% of girls and 18% of boys.

38
Q

Are tic disorders thought to have a biological basis?

A

Yes. Family history is often positive for ADHD, OCD and history of tics in first an second degree relatives. It is thought that connections in the Basal ganglia are involved.

39
Q

What is the association of Tic disorders and ADHD?

A
  1. 50% of TD patients meet the criteria for ADHD

2. 30-40% of children diagnosed with ADHD have tics or TD

40
Q

How are Tic disorders treated?

A

It is rare to achieve a greater than 50% reduction in a moderate to severely affected child.

  1. first line tx = alpha-2 agonists such as clonadine
  2. second line tx = atypical antipsychotics
  3. third line tx - typical antipsychotics
  4. habit reversal training - behavioral technique to reduce tics - very effective
  5. referral to specialist if moderate to severe TD or presence of substantial comorbidity
41
Q

What is Stereotypic movement disorder?

A

Repetitive, seemingly driven and apparently purposeless motor behavior such as hand shaking or waving, body rocking, head banging, self-biting or hitting of own body.

42
Q

What is the difference in between motor tics and stereotypic movement disorders?

A

Sterotypic movement disorder is characterized by movements that are complex and rhythmic - unlike tics.

43
Q

What is social pragmatic communication disorder?

A

Persistent difficulties in the social use of verbal and nonverbal communication as manifest by deficits in all of the following:

  1. deficits in using communication for social purposes, in a manner that is appropriate for the social contact
  2. impairment in the ability to change communication to match context or the needs of the listener
  3. difficulties following rules for conversation and storytelling
  4. difficulties understanding what is not explicitly stated
44
Q

What are some other criteria for diagnosis of social pragmatic communication disorder?

A
  1. deficits must result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance
  2. deficits must be present in the early developmental period, but may not become fully manifest until social communication demands exceed limited capacities
  3. deficits are not better explained by autism spectrum disorder, intellectual disability, global developmental delay or another mental disorder or medical condition
45
Q

Social pragmatic communication disorder is new to DSMV. It is meant to do what?

A

Provide a diagnosis for those who have similarities to Asberger’s or ASD but do not meet all that criteria. They still have relatively intact vocabulary, grammar and speech sound production abilities and no history of restricted/repetitive behaviors or interests.

46
Q

What are the risk factors for social communication disorder?

A
  1. family history of ASD
  2. family history of SLD (specific learning disability)
  3. family history of communication disorder
47
Q

What is on the differential diagnosis for social communication disorder?

A
  1. ASD
  2. ADHD
  3. social phobia
  4. intellectual disability
48
Q

What is the general treatment plan for social communication disorder?

A
  1. social skills training

2. speech/language therapy

49
Q

Autism spectrum disorder is new to DSMV. What used to be encompass this disorder?

A
  1. autistic disorder
  2. Asperger’s disorder
  3. childhood disintegration disorder
  4. pervasive developmental disorder NOS
50
Q

Autism used to be separated into types, now that there is one diagnosis - ASD - how are differences classified?

A

Specifiers can be used to describe variants. They describe inter individual differences.

  1. severity - what level of support is needed?
  2. with or w/o language impairment
  3. with or w/o intellectual impairment
  4. associated with known medical, genetic or environmental factors
  5. associated with another neurodevelopmental, mental or behavioral disorder
  6. associated with catatonia
51
Q

What are some concerns with the new ASD diagnosis?

A
  1. sensitivity has been ‘sacrificed’ in order to improve specificity
  2. merging may result in loss of uniqueness/ identity of Asperger’s disorder
52
Q

What is ASD?

A

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

  1. deficits in social-emotional reciprocity
  2. deficits in nonverbal communicative behaviors used for social interaction
  3. deficits in developing, maintaining and understanding relationships
53
Q

What are some other criteria for a diagnosis of ASD?

A
  1. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following, currently or by history:
  2. stereotyped or repetitive motor movements, use of objects, or speech
  3. insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
  4. highly restricted, fixated interests that are abnormal in intensity or focus
  5. hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
54
Q

List further criteria of ASD.

A
  1. symptoms must be present early in the developmental period but may not be fully manifest until social demands exceed capacity, or may be masked by learned strategies later in life
  2. symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning
  3. these disturbances are not better explained by intellectual disability or global developmental delay. intellectual disability and ASD frequently co-occur
55
Q

To make a comorbid diagnosis of ASD and intellectual disability, social communication should be what?

A

Below that expected for general developmental level.

56
Q

ASD was initially thought to be rare. What is the most recent prevalence?

A

1/88 in US. Prevalence varies worldwide but in all countries which keep data, it seems to be increasing in prevalence. Some of the increase (but not all) may be related to better detection, increased awareness and use of broader diagnostic criteria.

57
Q

Is ASD more common in males than females?

A

Yes. It has a 4:1 male to female ratio.

58
Q

What are some characteristics of ASD that support a biologically based etiology?

A
  1. proportion of risk attributable to genetics is 80% or higher
  2. recurrence rate of 18.7% in younger sibling
59
Q

What are some characteristics of ASD that support a multi-factorial etiology?

A
  1. no single genetic anomaly accounts for more than 1-2% of cases
  2. environmental factors associated include - prenatal rubella, thalidomide or valproic acid exposure
  3. risk factors include - low birth weight, prematurity and parental age
60
Q

Describe the diagnosis of ASD.

A
  1. Level 1 - screening
  2. Level 2 - Evaluation

a. Evaluation includes:
review of developmental history/presenting problems with parents
b. Review of available records
c. Direct interaction with observation of the child
d. Assessment of intellectual, language and adaptive functioning

61
Q

What measures are available to help with diagnosis of ASD?

A
  1. ADOS - the gold standard - involves structured play interview with child
  2. ADI-R - gold standard in research - involves an extensive interview with child and parents
  3. Social communication questionnaire
  4. M-CHAT - a screening tool
62
Q

ASD is associated with what comorbidities?

A
  1. genetic syndromes such as Tuberous Sclerosis
  2. Seizure disorder
  3. Intellectual disability
  4. Language impairment
  5. Self-injury
  6. Catatonia
  7. Psychiatric disorders
63
Q

What ar the rates of psychiatric comorbidity in ASD?

A

Studies of younger children with ASD (not Aspergers or older children) suggest a rate of comorbidity of 65-70%.

64
Q

List some rates of comorbid psychiatric conditions associated with ASD.

A
  1. social anxiety disorder - 29.2%
  2. ADHD - 28.1%
  3. Oppositional defiant disorder - 28.1%
  4. Generalized anxiety disorder - 13.4%
  5. panic disorder - 10.1%
  6. enuresis - 11%
  7. Sub-threshold depression or irritability - 10.9%
  8. Major depression - 0.9%
  9. Dysthymic disorder - 0.5%
  10. conduct disorder - 3.2%
65
Q

What are some psychiatric symptoms which may cause significant impairment and warrant intervention?

A
  1. hyperactivity/agitation
  2. impulsivity
  3. inattention
  4. restlessness
  5. aggression - tantrums, self injury, irritability, emotional lability
  6. repetitive, obsessive-compulsive type behaviors
  7. tics
  8. sleep problems
66
Q

How is ASD treated?

A
  1. requires a multi-disciplinary and multi-modal approach
  2. behavioral interventions are most effective
  3. developmental intervention is important - includes speech/language therapy, occupational therapy, physical therapy
  4. medical intervention used primarily to treat comorbid symptoms rather than core symptoms - such as irritability and agitation
  5. school interventions and advocacy are critical
  6. family support is critical
67
Q

What meds are FDA approved to treat irritability and agitation in ASD?

A

Risperidone and aripiprazole.

68
Q

What is global developmental delay?

A

This diagnosis is reserved for kids under the age of five when the clinical severity level cannot be reliably assessed during early childhood. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are too young to participate in standardized testing. Requires reassessment after time and those six and older do not qualify of this diagnosis.

Block 8 week 3 (9 decks)

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