Neurodevelopment Disorders

Question 1

Define ADHD

Answer 1

Attention deficit hyperactivity disorder (ADHD) = is a neurodevelopment disorder featuring the core features of:
* Difficulty maintaining attention
* Excessive energy
* Activity
* Impulsivity

Question 2

Which gender is ADHD more common in?

Answer 2

Males
(twice as likely)

Question 3

What factors are thought to cause ADHD?

Answer 3

• Genetic (there is significant heritability)
• Pregnancy-related factors (e.g., maternal smoking, premature birth and low birth weight)
• Environmental factors

Question 4

When do ADHD symptoms start and how?

Answer 4

In childhood
= Should be consistent across settings

When a person displays symptoms only at work or school but is calm and focused at home, this is suggestive of an environmental effect rather than an underlying diagnosis.

Question 5

Features of ADHD

Answer 5

When many of these features are present, and they are adversely affecting the person.

• Short attention span
• Easily distracted
• Quickly moving from one activity to another
• Quickly losing interest in a task
• Inability to persist with and complete tasks
• Constantly moving or fidgeting
• Impulsive behaviour
• Disruptive behaviour
• Difficulty managing time

The Adult ADHD Self-Report Scale (ASRS) can be used as a screening test to support a referral.

Question 6

Management of ADHD

Answer 6

Conservative management:
* Self-management strategies
* Reasonable adjustments

Medication (when conservative Mx fails): Central nervous system stimulants:
* Methylphenidate
* Dexamfetamine
* Lisdexamfetamine
* Atomoxetine

Question 7

What monitoring requirements are needed when taking medication (CNS stimulants) for ADHD?

Answer 7

• HR
• BP
• Weight
• Mood changes

Question 8

What are the 3 areas are impaired in ASD?

Answer 8

• Social interaction
• Communication
• Behaviour

Question 9

ASD: Name some deficits in social interaction

Answer 9

• Lack of eye contact
• Delay in smiling
• Avoiding physical contact
• Unable to read non-verbal cues
• Difficulty establishing friendships
• Not displaying a desire to share attention (e.g., not playing with others)

Question 10

ASD: Name some decifits in communication

Answer 10

• Delay, absence or regression in language development
• Lack of appropriate non-verbal communication (e.g., smiling, eye contact, responding to others and sharing interest)
• Difficulty with imaginative or imitative behaviour
• Repetitive use of words or phrases

Question 11

ASD: Name some decifits in behaviour

Answer 11

• Greater interest in objects, numbers or patterns than people
• Stereotypical repetitive movements (e.g., self-stimulating movements, such as hand-flapping or rocking)
• Intense and deep interests that are persistent and rigid
• Repetitive behaviour and fixed routines
• Anxiety and distress with experiences outside their regular routine
• Extremely restricted food preferences

Question 12

Name some members of an MDT for ASD management

Answer 12

• Child and adolescent mental health services (CAMHS)
• Psychologists
• Speech and language specialists
• Dieticians
• Paediatricians
• Social workers
• Specially trained educators and special school environments
• Charity organisations (e.g., National Autistic Society)

Question 13

Define learning disability

Answer 13

Learning disability = a general umbrella term encompassing a range of different conditions - that affect the ability of the child to develop new skills

Question 14

Define dyslexia

Answer 14

Specific difficulty in reading, writing and spelling.

Question 15

Define dysgraphia

Answer 15

Specific difficulty in writing.

Question 16

Define dyspraxia

Answer 16

AKA developmental co-ordination disorder

Specific type of difficulty in physical co-ordination.

It is more common in boys. It presents with delayed gross + fine motor skills and a child that appears clumsy.

Question 17

Define auditory processing disorder

Answer 17

Specific difficulty in processing auditory information

Question 18

Define non-verbal learning disorder

Answer 18

Specific difficulty in processing non-verbal information - such as body language + facial expressions

Question 19

Define profound and multiple learning disability

Answer 19

Severe difficulties across multiple areas - often requiring help with all aspects of daily life

Question 20

What is the severity of a learning disability bsaed on?

Answer 20

IQ (intelligence quotient):
* 55 – 70: Mild
* 40 – 55: Moderate
* 25 – 40: Severe
* Under 25: Profound

Question 21

Aetiology of learning disabilities?

Answer 21

No clear cause
Family history = increases the risk
Environmental factors = increase risk:
* Abuse
* Neglect
* Psychological trauma
* Toxins

Question 22

Name some conditions that have strong associations with learning disability

Answer 22

• Genetic disorders: Downs syndrome
• Antenatal problems: fetal alcohol syndrome and maternal chickenpox
• Problems at birth: prematurity and hypoxic ischaemic encephalopathy
• Problems in early childhood: meningitis
• Autism
• Epilepsy

Question 23

Management of learning disability

Answer 23

MDT:
* Health visitors
* Social workers
* Schools
* Educational psychologists
* Paediatricians, GPs and nurses
* Occupational therapists
* Speech and language therapists

Question 24

Is capacity decision-specific?

Answer 24

Yes!
Having a learning disability does not prevent patients from being able to make decisions

They may require more time, effort and decision aids to be able to fulfil the criteria. It may take several attempts on different days or at different times of day to be able to make a decision.

Question 25

To have capacity what are the 4 things that the patient must demonstrate?

Answer 25

• Understand the decision that needs to be made
• Retain the information long enough to make the decision
• Weigh up the options and the implications of choosing each option
• Communicate their decision

Remember that capacity is decision specific, meaning someone may have capacity to decide what they want for breakfast but not to decide whether to undergo complex surgery.