Neurodevelopmental

Question 1

What is a neurodevelopmental disorder

Answer 1

• Neurologically based disorder diagnosed in childhood or adolescence
• Include
  
  • ADHD
    Specific learning disorder
  • Autism Spectrum Disorder
  • Intellectual Disability
  • Communication and motor disorder

Question 2

ADHD Defining Features

Answer 2

• 6 or more inattentive symptoms and/or hyperactive symptoms
• Usually before age of 12
• Inattention
  
  • Fail to pay close attention to details
  • Difficulty keeping attention
  • Does not follow instructions
  • Does not finish schoolwork
  • Avoids tasks that require sustained attention
• Hyperactive
  
  • Fidgets or taps hands/feet
  • Leaves seat when expected to sit
  • Cannot play quietly
  • excessive talking
  • interrupts or intrudes
  • Difficulty waiting turns

Question 3

Associated features ADHD & diff diagnosis

Answer 3

• Specifiers
  
  • Predominantly inattentive presentation
  • Predominantly hyperactive presentation
  • Combined Presentation
• Differential diagnosis: hyperactivity/impulsivity in
  
  • Bipolar or conduct disorder

Question 4

Gender differences

Answer 4

• Boys to girls 3:1
• Boys tend to be more aggressive and act out frustrations
• Girls tend to internalize pain
  
  • girls symptoms are less disrupted and more tolerated less likely to be diagnosed
  • More likely to experience anxiety depression and eating disorders than those without ADHD

Question 5

Biological Causes ADHD

Answer 5

• Likely more genetic than environmental
  
  • Runs in families
  • Poor inhibitory control
  • Gene linked to dopamine? (lessons impact)
• US has highest diagnosis – do we expect children to sit still too much?
• Correlates
  
  • Smaller brain volume
  • Abnormal frontal lobe = planning and organizing

Question 6

Facts and Stats ADHD

Answer 6

• Most common in US
• 50% children w ADHD continue to have symptoms in adulthood
  
  • Higher divorce substance abuse STI etc
  • Impulsivity decreases inattention remains

Question 7

ADHD Environmental

Answer 7

• Toxins
  
  • Weak evidence food additive linked
  • Maternal Smoking?
  • More research needed
• Psychosocial
  
  • Kids w ADHD viewed negatively >> frequent negative feedback from adults
  • Peer rejection and social isolation could lead to low self esteem

Question 8

Bio treatment ADHD (types and implications)

Answer 8

• Goal: reduce impulsivity/hyperactivity
• Stimulant Medications
  
  • Ritalin Adderall
  • Could increase later substance abuse
• Nonstimulant medication: Strattera don’t produce highs
• Medication effects
  
  • Leads to more normal brain development
  • decreases negative behaviors
  • Improves focus on tasks for academics
  • If discontinued benefits stop
    
    • Is medicating children okay?

Question 9

Behavioral Treatment ADHD

Answer 9

• Behavioral Treatment
  
  • Reinforcement programs
  • Train parents
• Adults: CBT to increase attention
• bio-psycho-social treatments
  
  • Superior to any of them alone but more research needed

Question 10

Specific learning disorder

Answer 10

• Achievement below what’s expected for
  
  • IQ
  • Age
  • Education
• Reading disorder (dyslexia)
• Mathematics Disorder
• Disorder of written expression
• Difficulty for 6+ months despite intervention
• If person has sensory issues difficulties are excess what is expected

Question 11

Learning Disorder facts & Stats

Answer 11

• 5-10% prevalence in US
• More diagnosis in wealthier regions
  
  • bc have funds to test for it
• Reading difficulty 7%
  *

Question 12

Causes Specific Learning Disorder (genetic, social, other factors)

Answer 12

• Genetic
  
  • Learning disorders run in families but specific difficulties not inherited
  • Some evidence for neurological difficulties e.g. decreased functioning in areas responsible for word recognitions
• Psychosocial contributions
  
  • Some languages are more difficult to read
• Other factos
  
  • Motivation
  • SES status
  • Cultural expectations (girls expected to not do well in school)
  • Child management (e.g. allowing frustrated kids to give up on reading and watching TV instead)

Question 13

Treatments Specific Learning

Answer 13

• Intense educational interventions
  
  • Retraining basic processing skills
  • Target areas: vocabulary, fact-finding, critical thinking
• Data support educational interventions but modestly
• No medications developed

Question 14

Autism Spectrum Disorrder

Answer 14

• New Label includes several disorders including
  
  • Autistic Disorder
  • Asperger’s disorder“mild autism”
    
    • Loss of identity for “aspies”
  • Childhood disintegrative disorder: normal development then significant regression in behavior and motor skills
  • Rett syndrome: a genetic disorder involving problems with language coordination and repetitive movements

Question 15

Cluster 1 symptoms Autism

Answer 15

Impairment in Social Communication and Interaction

• Defining: failure to develop age-appropriate social relationships
  
  • Trouble initiating and maintaining relationships
  • Trouble with nonverbal communication
    
    • Trouble with eye contact, expressions, one
  • Trouble with social reciprocity
    
    • Deficits in joint interest: difficulty expressing interest in external stimulus and another person at same time

Question 16

Cluster 2 symptoms autism

Answer 16

Restrictive or repetitive behaviors and Interests

• Preference for status quo: maintain sameness
  
  • Change in routine upsetting
• Severe forms: ritualistic behavior to self soothe
  
  • e.g. spinning, clapping hangs, rocking, humming, self-injury
• Less severe forms: excessive interest in a specific topic
  
  • e.g. transportation, games, animals
  • Can make difficult to relate to others
  • Can also be a strength!

Question 17

Austism facts & stats

Answer 17

• Prevelance: 1 in everyone 500 births but appears to be increasing
  
  • Probably due to broadening of diagnostic criteria and greater awareness
• Worldwide occurrence
• Symptoms start before 36 months
• Males 4-5 times more likely than females
• 31% exhibit intellectual disabilities
• 25% never have effective speech
• 10% develop exceptional abilities in particular area but limited functioning in other areas

Question 19

Autism Causes

Answer 19

• Strongly genetic
• Older parents = increased risk
• Neurobiological influences
  
  • Amygdala: Large at birth; associated w more anxiety and fear
  • More cortisol = more stress
  • High stress = neuronal damage
• Oxytocin: low in ASD
• MMR vaccinations do NOT increase risk of autism

Question 20

Applied Behavior Analysis

Answer 20

• Applied Behavior Analysis
  
  • Intensive individualized treatment
  • Attempts to change behavior by assessing how problematic behaviors are reinforced
  • Develops replacement behaviors serving same function as problem behaviors
    
    • e.g. self-soothing techniques instead of self-injury
    • Positive reinforcement for demonstrating skills
    • Communication, social skills training
• Early Intervention may “normalize” function of developing brain (47%)

Question 21

Other treatments Autism (biological, integrated)

Answer 21

• Biological
  
  • Meds don’t help much
  • Anti agitation can help (tranquilizers, SSRIs)
• Integrated treatments: multidimensional focus
  
  • Families are given support
  • Children are given support at school for communication
  • Older: focus on integrating into the community and increasing independence
• Indicators of good prognosis
  
  • High IQ, language abilities

Question 22

Intellectual Disability

Answer 22

• Overview
  
  • Below average intellectual and adaptive functioning
  • First evident in childhood
  • Range of impairment varies
  • Previously mental retardation
• IQ below 70 (college students usually 110)
• Difficulties in three domains
  
  • Conceptual: (languages, reasoning, and knowledge)
  • Social (e.g. social judgement, ability to make friends)
  • Practical (e.g. difficulties managing personal care or jobs=

Question 23

Intellectual Disability: Facts & stats

Answer 23

• 1-3% gen population
  
  • 9 in 10 have a mild impairment (50 to 70 IQ)
• Chronic course
• Variable prognosis: independence possible for most when provided resources (skills training)

Question 24

Causes Intellectual Disability

Answer 24

• up 30% no defined etiology
• Hundreds of known causes
  
  • Environmental: neglect abuse (e.g. malnutrition)
  • Prenatal: exposure to toxins in the womb
  • Postnatal: problems after birth (head injury)
  • Genetic
    
    • Multiple genetic mutations
    • Single genes can be responsible
    • Chromosomal disorders (e.g. down syndome)

Question 25

Causes and detection down syndrome

Answer 25

• Most common chromosomal cause of intellectual disability
• Trisomy 21
• Distinct physical features
• Higher risk with advanced maternal age
• Prenatal tests detectable
  
  • Amniocentesis: test fluid around the body
  • Chorionic villus sampling (CVS)
  • Mother blood test
  • Tests do not measure severity of impairment
  • 25% mothers decide to terminate pregnancy

Question 26

Intellectual Disability Treatment

Answer 26

• Severe ID: similar to ASD (reinforcing appropriate behavior)
• Mild ID: similar for learning disorders (identify problem areas and build skills)
• Behavioral Interventions teach
  
  • Basic skills (dressing, hygiene)
  • Social Skills
  • Practical skills (e.g. paying bills)
• Common goals
  
  • Participate in community
  • Benefit from education
  • hold a jo or engage in productive pursuits (e.g. volunteering)
• Prevention: early intervention is critical
  
  • e.g. Head Start (educational, medical and social support for at-risk groups)