Neurodevelopment + Attention Disorders Flashcards
Females with ADHD present more commonly with which subtype; why is this a problem?
- Inattentive subtype
- Less disruptive behavior in females may contribute to referral bias causing under identification and lack of tx
What is the tourette’s syndrome triad?
- Tics
- ADHD
- Obsesseive compuslive sx’s (OCS)
Which other disorder needs to be considered in both the initial assessment and ongoing management of children with ADHD?
Chronic Tic Disorder
ADHD is an information processing dysfunction where in the brain; primarily due to deficinecy of which 2 NT’s?
- Within prefrontal cortex
- Deficiency of dopamine and norepinephrine
According to the DSM-5 how many sx’s should a child vs. patient >17 y/o have for making dx of ADHD?
- Children: should have 6 or more
- Adults: should have at least 5 sx’s
According to the DSM-5 what are 9 sx’s of the inattentive type of ADHD?
- Fails to give close attention to details or make careless mistakes
- Difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Difficult with organization + loses things + easily distracted
- Avoids or dislikes tasks requiring a lot of thinking
- Is forgetful in daily activities
According to the DSM-5 what are the sx’s that fit the hyperactive type of of ADHD?
What are the clinical practice guidelines for treating preschool-aged children (4-5 years of age) with ADHD?
- Prescribe evidence-based parent- and/or teacher-administered behavior therapy as the 1st line tx
- Prescribe methylphenidate if the behavior therapy does not provide significant improvement and the child continues to have moderate to severe sx’s
What are the clinical practice guidelines for treating elementary school-aged children (6-11 years of age) with ADHD?
- Prescribe FDA approved meds for ADHD and/or evidence-based parent and/or teacher-administered behavior therapy as tx for ADHD
- Preferably both medication and behavior therapy should be used together
- Evidnce is particularly strong for stimulant medications
What is a potential AE associated with Bupropion?
↑ risk of seizure
Which stimulant used for ADHD is a re-uptake inhibitor of catecholamines AND also releases catecholamines?
Amphetamines
Intellectual disability leads to…
intellectual deficiets and impairement of adaptive functioning
3 requirements:
- Deficits in intellectual functions
- Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards
- Onset during developmental period
Speech vs. Language vs. Communication Disorders
- Speech: difficulty with speech sound production
- Language: difficulty with acquisition and use of language
- Communication: disturbances in normal fluency and time patterning of speech (difficulty with sequencing)
onset for all occurs early developmental period
How does autism manifest?
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communicative behaviors used for social interaction
- Deficits in developing, maintaining, and understanding relationships
- Restrictive, repetitive patterns of behavior (at least two):
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible routines
- Highly fixated interests
- Hyper or hypo reactivity to sensory input
What is the most important behavioral intervention for cases of autism?
education and support for family members + teachers
teach about parallel processing
What medications are approved for ASD?
risperidone and aripiprazole for the irritability and agitation
What is Tourette’s Triad
OCS
ADHD
Tics
Dx criteria for chronic tic disorder
motor OR vocal tics
wax and wane in frequency, but persist more than one year
onset before age 18
*higher in kids with ADHD
The tx for ADHD with stimulants can have what effect on associated tics?
increased
The executive functioning is dysfunctioning in ADHD due to…
located in prefrontal cortex
def of DA and NE
What tests can be useful in ADHD dx?
- Test of Variables of Attention (TOVA)
- Conners Continuous Performance Test (8 y/o+)
What are some alternative medications (other than stimulants) for ADHD?
- Guanfacine, Clonidine: alpha 2 agonists; modulate noradrenergic tone in PFC
- Bupropion
- Atomoxetine: inhibits presynaptic NE reuptake; used with caution in CV risk
- Modafinil: adults only, inhibits DA reuptake
What is developmental coordination disorder?
coordinated motor skills below expected
manifests as clumsiness, inaccuracy in motor performance…
significant enough to interfere with academics, daily life…
What condition is marked by repetitive, seemingly driven, and apparently purposeless motor behavior?
stereotypic movement disorder
Criteria for Tourette’s Disorder
multiple motor AND verbal tics present (though do not have to be at the same time) for over one year
onset prior to age 18
comorbidities: ADHD, OCD, anxiety, mood disorders, risk of suicide, disruptive behaviors, learning disabilities, sleep disorders
