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PSYCHIATRY > Learning disability, developmental delay and ADHD > Flashcards

Learning disability, developmental delay and ADHD Flashcards

1
Q

What is the prevalence of learning disability in the general population?

A

3%

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2
Q

What are the 3 main criteria for diagnosis of learning disability?

A

IQ <70
Developmental cause presenting before age 18
Deficits in adaptive functioning

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3
Q

What is the ‘flynn effect’?

A

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

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4
Q

Downs syndrome (trisomy 21) has a strong association with the development of which condition later in life?

A

Alzheimer’s dementia

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5
Q

What conditions do the different sex chromosome abnormalities cause?

A

45 X = Turner’s

47 XXY = Klinefelter’s

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6
Q

What are the IQ cut offs for the different categories of learning disability, from borderline to profound?

A 
Borderline : IQ 70+ 
Mild: IQ 50-69 
Moderate: IQ 35-49 
Severe: IQ 20-34 
Profound : IQ< 20
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7
Q

What is the severity of learning disability in patients with Down’s syndrome?

A

Moderate (IQ 35-49)

Limited achievements, delayed self care and motor skills, epilepsy and physical disabilities are common

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8
Q

What are the common comorbidities associated with learning disabilities?

A 
Epilepsy 
Mental illness 
Dementia 
Hypothyroidism 
CVS conditions
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9
Q

What is the ‘O’Brien principle’?

A

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

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10
Q

Schizophrenia is 3 x more common in patients with learning disability. What symptoms of schizophrenia are they most likely to have?

A

Negative symptoms

unexplained aggression, social withdrawal, mood lability e.t.c

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11
Q

Why are patients with learning disabilities more likely to have comorbid conditions?

A

Organic vulnerability (brain damage)

Social deprivation

Psychological reasons

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12
Q

Why are comorbid conditions under diagnosed in patients with learning disability?

A 
Diagnostic overshadowing 
(symptoms attributed to the LD)

Compliance
(patient can be talked out of their symptoms)

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13
Q

What are the 4 main areas for development in childhood?

A

Gross motor

Fine motor and vision

Language and hearing

Social behaviour and play

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14
Q

How can developmental delay be defined?

A

Failure to attain appropriate developmental milestones for the child’s corrected chronological age

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15
Q

What are the 3 patterns of abnormal development?

A

Delay

Deviation

Regression

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16
Q

What are the red flags for delayed development?

A

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

17
Q

What are the criteria for global developmental delay?

Give an example of a condition

A

Significant delay in 2+ of the 4 areas of development

E.g Down’s syndrome

18
Q

Give an example of a condition which involves developmental deviation

A

Autism spectrum disorder

19
Q

How common is autism spectrum disorder?

A

About 1% of the UK child population

20
Q

What 3 things make up the autistic triad?

A

Communication

Social interaction

Flexibility of thought and imagination

21
Q

Describe the communication difficulties in patients with ASD

A

Delayed receptive and expressive language

Odd intonation and pitch

Chunks of video speak

22
Q

Describe social interaction in patients with ASD

A

Unable to share pleasure

Not motivated by the need for social approval

23
Q

Describe flexibility of thought and imagination in patients with ASD

A

Concrete and literal

Need routines

Don’t react well to changes in their environment

24
Q

What sensory difficulties might a patient with ASD have?

A

Fussy eater

Fussy with medications

Don’t like getting nails and hair cut/ washed

Don’t like loud noises

*Anything which involves sensory overload

25
Q

What are the development assessment tools which can be used to screen for developmental delays?

What ages are they used for?

A

0-8 yrs: Griffiths

0-3 yrs: Bayleys

0-5 yrs: Schedule of growing skills

Suspicion of ASD: ADOS

26
Q

What does ADHD stand for?

A

Attention deficit hyperactivity disorder

27
Q

What is the diagnostic train for ADHD?

A

Inattention

Hyperactivity

Impulsivity

28
Q

What comorbid symptoms may a patient with ADHD have?

A

Mood and anxiety problems

Attachment issues

Substance misuse

Learning difficulties

Social communication difficulties

29
Q

What type of memory problems do patients with ADHD have?

A

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

30
Q

What is the prognosis like for ADHD?

A

Symptoms commonly remain throughout childhood and the core symptoms may persist into adulthood

Some will ‘grow out’ of ADHD as the brain naturally develops

31
Q

What categories of treatment options are there for patients with ADHD?

A

Psychological therapies

Pharmacological therapies

32
Q

What psychological therapies are available for patients with ADHD?

A

Parent training

Behavioural classroom management strategies

Social skills training

Diet eliminations and supplements

33
Q

What pharmacological options are available for patients with ADHD?

A

Stimulant medication
E.g methylphenidate (ritalin)

Non stimulant medication
E.g Atomexetine and antidepressants

34
Q

What is the mechanism of action of methylphenidate (ritalin)?

(1st line for ADHD)

A

Improves dopaminergic neurotransmission in networks involved in executive functioning (e.g in the prefrontal cortex)

35
Q

What are the side effects of methylphenidate (ritalin)?

A

Side effects are usually minor (e.g sleep and appetite reduction)

Other S/E; dysphoria, anxiety and tics

36
Q

What is the mechanism of action of atomoxetine?

2nd line for ADHD

A

Noradrenergic and dopaminergic agonist

37
Q

What is the mechanism of action of guanfacine, a medication which can be used in the management of ADHD?

A

Alpha 2 agonist

PSYCHIATRY (11 decks)

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