Intellectual Disability and Tic Disorders Flashcards
Intellectual Disability
Onset during developmental period that includes both intellecutal and adaptive functionign deficits in conceptual, social and practical domains
3 cirteria must be met
Crtieria A of intellectual disability
Defined by IQ
Intellectual
70 or below
Crtierai B of intellectual disability
Adaptive functioning
Failure ot meet standards for indepence and social responsbility
Adaptive deficits limit functioning in daily life
Adaptive functioning
Skills needed to live in an independent and responsible manner
Skills for daily liiving
Communication
Social skills
Personal independce
School/work functioning
Criteria C of intellectual disability and levels
Onset during the developmental period (childhood/adolescne)
If problems are after, then neurocognitive disorder
Mild/mod/severe/profound
Heredity Early alterations of embryonic development Environtmental influence Mental disorders Pregnancy/perntala probs
Fragile X, metab Trisomy, damage due to toxins Nurutrance derpvity Autistic Fetal malnutrition, prematurity, hypoxia
3 most common causes of ID
Down’s syndrome - most common genetic course (chromosome 21)
Fragile X - most common inherited (x-linked FMR-1)
Fetal alcohol syndrome - grwoth retardation, developmental delay, and faical features)
Cornerstones of ID evaluation
Hisotyr of functiongi nfrom other sources
Neuropscyhitric and adaptive behavior testing
Most commmon co-morbid with ID
ADHD
Depression
Autism (7–80% pf autistic have intellecutal impairment)
Aggesssion and ID and tx
Behaviorla tx is 1st followed by meds
Main reason for consultation
Slef-jury and tx
Reptitive acts that occur in an identical form
Behavior therapy is main
Meds can also address compulsive acts
Stereotypy and tx
Invariant behaviors or action sequences without an obvious reinforcement pattern
Seen in circumstances of extreme stimulation or deprivation
Bahvior therapy and SSRIs
Tx of ID
Treat underlying disorders, QOL, etc
Pharmacotherapy
Stimulants - for hyperactivity, inattention, and impulsivity
Non-stimulants (strattera) - hyperacitive, inattnetion, impulsiity
SSRIs - depression and anxiety
Antipsychotics - aggression, slef-injurious behaviors
Tic disorders
One second or less and are voluntary that can be anticipated
Sudden, rapid, recurrent, non-rhythmic movement
tic demo
Boys much higher
Tourette’s and environment
Maternal nausea, low brith weight, forceps delivery
Stimulant therapy induces earlier onset
Group A B-hemolytic strep infection leading to AI disorders
Tic onest, peak, and reduction and course
5-6 onset
10-12 peak
15-17 reduction
Occur in bouts and wax and wane
Suppressinble to a degree
Tic encouragers
Stress and anxiety
Decrease during sleep and absorbing activities
Simple vs complex tics
Simple - one muscle group
Complex - multiple
Complex vocal tics
Single words or phrases
SPeech blokcing
Changes in prosidy
Echolalia or coprolalia (rare)
Tourette’s
Both multiple motor and one or more vocal have been present
Tics may wax and wane in frequency but have persisted for 1 years
Onset befroe 18
Course of tourettes
Starts young with motor, then vocal
Strts in head and face then body
Starts simple then mre ocmplex
Persistnet (chronic) motor or vocal tic disorder
Exact same BUT cannot have both motor and vocal
Tx of tic disorders
Supportive, educationla, and psychotherapuetic interventions for patients and families
Pharm
Tourette’s often seen as triad with ADHD and OCD
Meds for tics
Alpha-2A agonists - clonidine and guanfacine - diminish dopamine levels and stimulate inhibitory cortical functions
Antipsychotics - typical and atypical - blcok dopamine receptors
