Neurodevelopmental/ADHD 1 Flashcards
1
Q
ASD Symptoms and Signs: Social reciprocity (7)
A
- Give and take of social interaction—must recognize another person’s perspective
- Trouble establishing relationship with peers
- May not empathize well
- Joint attention or ability to attend to an activity with another person is lacking
- Can’t point to an object (protoimperative pointing)
- Pointing to draw something to the attention of another (Protodeclarative point) more important
- Looks at mouth, not eyes; Lack of good eye contact
2
Q
ASD DSM V Criteria
A
- Restricted, repetitive pattern of behavior, interest, or activities as manifested by:
A. Stereotyped or repetitive motor movements, echolalia, idiosyncratic phrases
B. Insistence or sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior
C. Highly restricted, fixed interests that are abnormal intensity or focus
D. Hypo or hyper reactivity to sensory input
3
Q
ASD DSM V Criteria Severity
A
Severity is based on the degree of social communication impairment (A) and restricted, repetitive patterns of behavior (B)
c) Symptoms must be present in early development (may become more manifest as social demands exceed capacity)
d) Symptom cause significantly different impairment in social, occupational or other important areas of current functioning
e) These disturbances are not better explained by intellectual developmental disability
4
Q
Assessing development (6)
A
- Make sure there is a clear way of triaging children in primary care that belong in the ED
- Assess severity of all symptoms—functional impairment is key
- Emphasize the child’s functioning –if severe belongs with a mental health professional
- Assess sleeping pattern
- Identify what are the environmental factors that may have precipitated any change
- The Safe Environment for Every Kid (SEEK questionnaire)
5
Q
Inattention/Impulsivity (3)
A
- Symptoms that do not rise to a level of disorder
- Occur commonly in children
- Child’s teacher may observe symptoms of:
a. Excitability, impatience, angry outburst (more than seen in peers)
b. Wandering attention (Greater than is seen in peers)
c. Difficulty with behaviors at home or in classroom
d. Academic difficulties
e. Parent and teacher assume this is ADHD
6
Q
Inattention/Impulsivity vs ADHD
A
For some children, impulsivity and inattention limit adaptability to normal peer and family situations but extremes of these behaviors warrant attention for ADHD disorder
7
Q
Treatment of Mild Inattention and Impulsivity (5)
A
- Reinforcement of good behavior
- Reinforce the strengths of the child. (Strength based approach)
- Build trust and develop a plan of care using shared decision making
- Reduce stress on the child—consider parental mental health.
- Symptoms of inattention are generally worse under stress
8
Q
Four types of learning disorders
A
- Reading Disorder
- Mathematics disorder
- Disorder of written expression
- Learning disorder not otherwise specified
9
Q
Testing for Learning Disability (5)
A
- Intelligence tests
- Achievement tests
- Full psychoeducation evaluation; done by psychologist or by school psychologist
- School placement and special services
- Individualized educational program is already in place
10
Q
Management of Learning Disability (5)
A
- Engage child and family in care
- Encourage healthy habits—sleep, exercise, and diet
- Reduce stress
a. Is the parent punitive or critical?
i. Encourage them not to compare with siblings or peers
ii. Nurture nonacademic gifts
iii. Provide positive social experiences - Ask about homework battles?
- Are school authorities proceeding with assessments within the child’s rights
a. Individuals with disabilities act
b. Section 504 rehabilitation act
11
Q
Guidelines for PNP to Help Parents with Homework Battles (12)
A
- Establish a regular routine
- Identify another student your child can call to clarify homework assignments
- Limit distractions (TV, phones)
- Assist child in getting started (read directions together, watch child do first item)
- Monitor without taking over
- Do not insist on perfection*; Don’t over pressure the child
- Offer incentives
- Help child study for tests
- Do not force the child to spend extra or excessive time on homework.
- If child tried but wasn’t able to do it give praise to the child and write a note to the teachers
- If child did not turn it in after completing it, develop a plan with the teacher
- Ask for a tutor, if homework time is getting to be a battle.
12
Q
Prevalence and Impact of ADHD (6)
A
- Prevalence rate of 5% of Children and 2% of adults
- More prevalent in males than females
- Male: female ratio is 2:1 in epidemiological samples
- Ranges from 3:1 - 9:1 in clinical samples 50% of children referred to mental health clinics are referred for ADHD-related problems
- Preschoolers tend to have more hyperactivity
- Annual societal cost of illness for ADHD estimated to be between $36 - 52 billion $12,005 – $17,458 annually per individual
13
Q
Comorbidities Associated with ADHD (6)
A
- ODD (50-60%) – primary or secondary
* Opposition defiant disorder - Mood and anxiety disorders (20-40%) – chicken and egg; if having problems at school, may become anxious
- Learning disorders / language disorder (25-35%) – if having developmental disorders, often travel together
- Substance abuse disorders (15%)
- If you have ADHD, 15% chance you also have substance abuse disorder
- Untreated ADHD increases risk of substance abuse
14
Q
Criteria A1: Inattentive Symptoms of ADHD (9)
A
- Often fails to give attention to details or makes careless mistakes in schoolwork, at home, at work or in other activities
- Often has difficulty sustaining attention in tasks or play activities (difficulty staying with reading, listening during lectures)
- Often does not seem listen when spoken to directly in the absence of obvious distractions
- Often does not follow through on instructions and fails to finish schoolwork, shoes or duties in the workplace
- Often has difficulty organizing tasks and activities
- Often avoid, dislikes or is reluctant to engage in tasks that require sustained mental effort
- Often loses things necessary for tasks or activities
- Is often distracted by extraneous stimulus (may include unrelated thoughts for adolescent or adult)
- Is forgetful in daily activities
15
Q
Criteria 2a: Hyperactive Symptoms of ADHD (9)
A
- Hyperactivity
- Squirms and fidgets with hands or feet
- Leaves seat in situations when remaining seated is important
- Often unable to play or engage in leisure activities quietly
- Blurts out an answer before a question has been completed (cannot wait for turn
- Runs and climbs excessively
- Difficulty waiting his turn
- Talks excessively
- On the go/driven by a motor
