Learning disability, developmental delay and ADHD Flashcards
What is the prevalence of learning disability in the general population?
3%
What are the 3 main criteria for diagnosis of learning disability?
IQ <70
Developmental cause presenting before age 18
Deficits in adaptive functioning
What is the ‘flynn effect’?
As a population we have been scoring higher on IQ tests by about 10 points per generation
Thought to be related to better schooling and nutrition e.t.c
This is now starting to slow down
Downs syndrome (trisomy 21) has a strong association with the development of which condition later in life?
Alzheimer’s dementia
What conditions do the different sex chromosome abnormalities cause?
45 X = Turner’s
47 XXY = Klinefelter’s
What are the IQ cut offs for the different categories of learning disability, from borderline to profound?
Borderline : IQ 70+ Mild: IQ 50-69 Moderate: IQ 35-49 Severe: IQ 20-34 Profound : IQ< 20
What is the severity of learning disability in patients with Down’s syndrome?
Moderate (IQ 35-49)
Limited achievements, delayed self care and motor skills, epilepsy and physical disabilities are common
What are the common comorbidities associated with learning disabilities?
Epilepsy Mental illness Dementia Hypothyroidism CVS conditions
What is the ‘O’Brien principle’?
Learning disabled people will not grow out of their learning disability but they can continue to grow and develop in an appropriate environment
Important for them to have the availability of everyday normal conditions of life
Schizophrenia is 3 x more common in patients with learning disability. What symptoms of schizophrenia are they most likely to have?
Negative symptoms
unexplained aggression, social withdrawal, mood lability e.t.c
Why are patients with learning disabilities more likely to have comorbid conditions?
Organic vulnerability (brain damage)
Social deprivation
Psychological reasons
Why are comorbid conditions under diagnosed in patients with learning disability?
Diagnostic overshadowing (symptoms attributed to the LD)
Compliance
(patient can be talked out of their symptoms)
What are the 4 main areas for development in childhood?
Gross motor
Fine motor and vision
Language and hearing
Social behaviour and play
How can developmental delay be defined?
Failure to attain appropriate developmental milestones for the child’s corrected chronological age
What are the 3 patterns of abnormal development?
Delay
Deviation
Regression
What are the red flags for delayed development?
Assymetry of movement
Not reaching for objects by 6 months
Not walking by 18 months
Unable to sit unsupported by 12 months
No speech by 18 months
Concerns with vision or hearing
Loss of skills
What are the criteria for global developmental delay?
Give an example of a condition
Significant delay in 2+ of the 4 areas of development
E.g Down’s syndrome
Give an example of a condition which involves developmental deviation
Autism spectrum disorder
How common is autism spectrum disorder?
About 1% of the UK child population
What 3 things make up the autistic triad?
Communication
Social interaction
Flexibility of thought and imagination
Describe the communication difficulties in patients with ASD
Delayed receptive and expressive language
Odd intonation and pitch
Chunks of video speak
Describe social interaction in patients with ASD
Unable to share pleasure
Not motivated by the need for social approval
Describe flexibility of thought and imagination in patients with ASD
Concrete and literal
Need routines
Don’t react well to changes in their environment
What sensory difficulties might a patient with ASD have?
Fussy eater
Fussy with medications
Don’t like getting nails and hair cut/ washed
Don’t like loud noises
*Anything which involves sensory overload
What are the development assessment tools which can be used to screen for developmental delays?
What ages are they used for?
0-8 yrs: Griffiths
0-3 yrs: Bayleys
0-5 yrs: Schedule of growing skills
Suspicion of ASD: ADOS
What does ADHD stand for?
Attention deficit hyperactivity disorder
What is the diagnostic train for ADHD?
Inattention
Hyperactivity
Impulsivity
What comorbid symptoms may a patient with ADHD have?
Mood and anxiety problems
Attachment issues
Substance misuse
Learning difficulties
Social communication difficulties
What type of memory problems do patients with ADHD have?
Deficits in both executive and non-executive aspects of working memory
*Working memory in children with untreated ADHD resembles that of elderly patients with alzheimer’s
What is the prognosis like for ADHD?
Symptoms commonly remain throughout childhood and the core symptoms may persist into adulthood
Some will ‘grow out’ of ADHD as the brain naturally develops
What categories of treatment options are there for patients with ADHD?
Psychological therapies
Pharmacological therapies
What psychological therapies are available for patients with ADHD?
Parent training
Behavioural classroom management strategies
Social skills training
Diet eliminations and supplements
What pharmacological options are available for patients with ADHD?
Stimulant medication
E.g methylphenidate (ritalin)
Non stimulant medication
E.g Atomexetine and antidepressants
What is the mechanism of action of methylphenidate (ritalin)?
(1st line for ADHD)
Improves dopaminergic neurotransmission in networks involved in executive functioning (e.g in the prefrontal cortex)
What are the side effects of methylphenidate (ritalin)?
Side effects are usually minor (e.g sleep and appetite reduction)
Other S/E; dysphoria, anxiety and tics
What is the mechanism of action of atomoxetine?
2nd line for ADHD
Noradrenergic and dopaminergic agonist
What is the mechanism of action of guanfacine, a medication which can be used in the management of ADHD?
Alpha 2 agonist
