Infancy and Toddlerhood Flashcards
Describe some strategies used to treat epilepsy, apart from the commonly prescribed Anti-Epileptic Drugs
Ketogenic diet, Avoiding the triggers, Modify lifestyle, Use relaxation techniques, Avoid stress, techniques for managing brain’s electrical activity, Resection or disconnection surgery if lesions are focal
Ketogenic diet reduces the amount of glucose, forces body to use fats for energy -> impacts brain activity
Is the propositon true? “Adults with epilepsy have intellectual disabilities”
Epilepsy and intellectual brain disability have the same underlying causes such as brain trauma and gene mutations. Therefore, it’s a common mistake to think that but it depends on the person, just like people without epilepsy. They may or not have intellectual disabilities. Some types of epilepsy may cause intellectual disability like dravet syndrome where the severe epilepsy manifests with intellectual disability.
True or false? “No one with epilepsy can drive a car”
False. Depends on the case. Certain aspects of epilepsy can make it dangerous to drive. Generalized seizure occurs with loss of consciousness and muscle spasms; and
focal seizure depending on the region, can occure with many different symptoms (flashing lights, muscle spasms, etc.). If the type, frequency and severity of epilepsy is not incapacitating, they could be allowed to drive. For example, someone who only has epilepsy during their sleep or only have it once a year could be allowed to drive.
True or false? “As long as they do not have any seizures, people with epilepsy have normal lives”.
Generally true. If the seizures are under controlled, with medication or other techniques, they can have normal lives. However, the stigma around epilepsy can raise issues. They’d more likely to experience social isolation, less likely to build and hold close romantic relationships or a successful career.
Describe how the brain development of people with autism differs from those without autism.
- Brain overgrowth (espc. in frontal cortex and amygdala )
- regional differences in growth
- Abnormalities in the cerebellum
- Abnormalities in neurotransmitter systems dopamine, serotonin, glutamate. imbalances can influence mood regulation, behavior.
- atypical brain activity
- asynchronous development (different areas develop at different rates)
True or false? “Talking to someone with autism will be awkward”
Autism is characterized by problems with communication and language. This issues can be difficulties with central coherence, social cognition, understanding theory of mind. PwASD could have issues picking up on social cues, with empathy, often might talk excessively about their specific interests, or issues with intonation. But, not every PwASD is the same, the behavioral symptoms vary depending on where they’re on the spectrum, and each person is different. Some people without autism might believe talking to someone with autism will inevitably be awkward, which can cause deeper social issue for the PwASD. However, this is not true. It’s possible to have regular, comfortable,and engaging conversation with PwASD.
True or False? Girls with autism have different symptoms than boys with autism
True. There are some sex differences in behavioral manifestations of autism:
Girls generally tend to have better social communication skills, therefore girlswASD is more likely to be better at social skills, building and maintaing conversations. And,
the intense interests of girls tend to be in areas like novels, animals, etc. compared to boys (automobiles, math, etc.).
Why might girls with autism have better social communication skills than boys with autism?
Girls tend to be better at observing and mimicing social behavior than boys, this allows them to blend in.
And, girls tend to develop better verbal communication skills than boys early on in development. This also help immensely with social communication skills.
True or False?Adults with autism usually do not have a partner or kids
False. There are some behavioral symptoms of autism, like social cognition or theory of mind, which can make it difficult for PwASD to build and maintain meaningful relationships, but they can still lead successful family lives. They might have different needs than others, but that doesn’t necessarily mean that they can’t have partners or kids. If they have a partner who understands their condition and is willing to accommodate their needs, they can have happy relationships. Their parenting styles can be different than those who are not on the spectrum, they might speak to kids differently, or have a more structured way of communication and living, but this doesn’t mean they can’t be good parents. And, if they have external support, like getting therapy, this can help with managing their interpersonal relationships and help them sustain a happy family life.
Emma (3 years) had a Medulloblastoma in infancy that was successfully treated with surgery and radiotherapy. She was healthy for a few years, but recently experienced a seizure. The parents of Emma come into your practice to receive psycho-education about their daughter’s condition.
A. First, you grab a picture of the brain and point to the place of the tumor. Name the brain area (1 points).
B.Answer this question of the parents: “Does the seizure mean that Emma now has epilepsy?”
(2 points)
C. Also, answer this question of the parents: “Can the seizure be caused by the brain tumor?”
(2 points)
D. Tell the parents as much as you can about Emma’s prognosis for her future life. What can they expect, based on the tumor Emma had, the treatment she received, and the seizure she had? (5 points)
A. Typically medulloblastoma arises in cerebellum. Located in the lower back part of the brain and is responsible for movement, balance, and fine motor skills.
B. Not necessarily. Seizures are physical symptoms of epilepsy but one seizure in her lifetime doesn’t mean she has epilepsy. Epilepsy diagnosis requires at least 2 seizures. As she has had radiotherapy and surgery, this seizure might be affected by a scarring from her surgery or the radiation effect or other neurological changes. We’ll need to further assess and monitor her condition to determine whether it’s epilepsy.
C. Yes, the seizure might be the result of the brain tumor or the radiation she received. Even though the tumor was removed, there could be a scarred or changed tissue after these interventions which could’ve led to a seizure.
D. Patients with brain tumor , when caught and treated early, may still have a long-term survival rate. Seeing that Emma has been healthy for a few years is a good sign. But it’s beneficial to continue monitoring to catch a possible implication early. Also, as I mentioned, the medulloblastoma is generally located in cerebellum, which is responsible for movement, balance and fine motor skills. Even though the tumor has been removed, the tumor still may have an impact on her motor skills in her life. And, the radiotherapy might have impacted her cognitive development, which can result in learning difficulties or developmental delays. However ,we should keep in mind this doesn’t necessarily have to happen, as her brain has a high plasticy and is able to adapt and reorganize itself to overcome such challenges. We should keep in mind that close monitoring will help immensely with the early detection of developmental, cognitive, motor or neurological issues. If we can detect early, we can also address them early, and apply necessary interventions. She may need some extra support from now on, but given that she receives the appropriate interventions, and social support, especially from her close family, she could have a high quality of life. There are children who have experienced medulloblastoma and went on the lead healthy and happy lives.
You go to an expert meeting on cognitive development and get into a discussion about domain-general and domain-specific development. You are a strong believer of domain-general development.
A. Explain what domain-general and domain-specific development entail (4 points).
B. Argue why you support the domain-general view of development? (3 points)
One consequence of domain-general development, is that impairments in one cognitive skill can
negatively affect the development of other skills.
C. Provide an example of how impairments in one cognitive skill can negatively affect the
development of other skills (3 points)
A. Domain- Specific Idea refers to the idea that the development and the brain structure is modular and localized. Individual cognitive skills develop according to a unique timelin and there’s no overlap in their development processes.
Domain -General Idea refers to the idea that skill development is dependent on a range of cognitive processes. These development stages and skills areas overlap.
B. I support domain general because, as we frequently see, impairment of one particular skill development also impacts other skill developments. These skills and developmental areas are interconnvected, and rely on shared underlying processes, for example executive functions; attention, memory, processing speed, socio-emotional skills are fundamental for variety of tasks, showing how they’re connected with one another. Also, there are researched showing that early childhood development often involves the simultaneous improvement of multiple skills. For example, the development of attention and executive function support both language acquisiton and motor development. This support the idea that cognitive growth is supported by general mechanisms. Finally, environmental factors usually have a broad domain-general effect on development. For instance, very early childhood language development can enhance language, social and cognitive skills simultaneously.
C. For example; if a child has working memory deficit, he or she may experience difficulty in reading comprehension. Impaired working memory - in other words a deficit in temporarily holding and manipulating information- might result in difficulty of comprehending written material. Reading comprehension requires a functioning working memory to encode what was read, retain information as they read, therefore resulting in challenges to understand and making sense of the material they just read.
Tess (3 years) comes to your practice with her parents. They are worried about her language development. They have noticed something very unusual. They thought Tess was not able to speak yet, but overheard her playing with her doll while talking to her baby doll. They heard Tess speak short sentences to the doll, like “baby now sleeps”. However, when they asked her to say the words again, Tess refused and just shook her head. They came to your practice for advice.
* Upon first reflection, what do you think is going on in Tess’s brain that might be related to her symptoms? Name the two specific brain areas that could be involved in her symptoms (4 points)
* What would be normal development for a child at Tess her age? In other words, what are most children of her age able to do in terms of language development? (2 points)
* What do you tell the parents about Tess’s language development? (4 points)
A. Considering Tess can clearly understand her parents and has no issues with language comprehension and production in some settings; the brain areas that are responsible for these language skills (Broca’s and Wernicke’s areas) are not impacted. If she can produce speech on her own but can’t on command, this can point to a difficulty in accessing language voluntarily. This could also be due to Selective Mutism. Selective Mutism is when a child has the capability to understand and produce language, but refrains from speaking in certain situations. Usually the situations where the child is expected to speak creates anxiety. In Tess’ case, Amygdala, as the main part for processing fear and anxiety might be hyperactive, resulting in an anxiety disorder. The issue is not due to a developmental delay, as we see her understand her parents saying “say that again” and refusing it with a headshake; and she is seen speaking to a doll with a good sentence structure for her age. This seems be to a results of socio-emotional skills, and, along with amygdala, her prefrontal cortex might also be involved. Prefrontal cortex’s responsiblity in social inhibition is relevant in this case.
B.Tess appears to be have an appropriate level of language skills. At age, 3 years old, although the range might vary, a child is capable of producing sentences with 3-4 words or longer, can understand basic commands just like Tess being asked to repeat the words again and responding to it. They have a big vocabulary with around 1000 words, and are able to engage in conversations. Tess’ language skills seem to be intact, however her refusal to speak suggests an emotional or social issue.
C. I would reassure the parents on her language skills. She responds with a head shake when asked to repeat words, we can interpret it as her understanding the command. She also is able to produce speech as she was heard speaking to her doll, her sentence is also pretty well-structured, so overall her language development is not impaired. However, the underlying issue might be due to anxiety. This is most likely selective mutism where the language production and comprehension is spared but due to high anxiety the child refuses to speak when they’re expected to speak. I would suggest a further evaluation to identify the underlying cause, and could recommend some interventions such as speech therapy. Early interventions could help immensely.
What are ASD diagnosis criterias?
- Difficulty w communication and interaction with others
- Restricted interests and repetitive behavior
- Symptoms that hurt the person’s ability to perform at school, work or other areas.
Characterized with social impairment
Mostly diagnosed at 2-3 y.o.
Possible comorbidities with ASD?
- Down syndrome
- ADHD
- Seizure disorder
- anxiety
What does an ASD brain look like?
- Can’t pinpoint to one area, mostly due to comorbidities
- Overgrowth in early postnatal period is seen in frontal and temporal cortex
- overgrowth in amygdala
- hyperconnectivity in the brain
