Neurodevelopmental and Attention Disorders Flashcards
When do neurodevelopmental disorders typically manifest?
Early childhood, often before the child enters grade school
How are neurodevelopmental disorders characterized?
Deficits that produce impairments of personal, social, academic, or occupational functioning
How are intellectual disabilities characterized?
Deficits in general mental abilities, including:
reasoning
problem solving
planning
abstract thinking
judgment
academic learning and learning from experience
Deficits associated with intellectual disabilities result in what?
Impairments of adaptive functioning
(communication, social participation, academic or occupational functioning, personal independence)
Global developmental delay is used as a diagnosis in what circumstance?
In individuals who are unable to undergo assessments of intellectual function
(i.e. children who are too young, those with acquired insult during the developmental period, severe head injury)
In addition to intellectual and adaptive functioning deficits, what three criteria must be met for a diagnosis of intellectual developmental disorder?
Must have:
- Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, etc. confirmed by both clinical assessment and intelligence testing
- Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility
- onset during the developmental period
The three domains of adaptive functioning deficits
Conceptual domain
Social domain
Practical domain
What characterizes the conceptual domain of adaptive functioning deficits?
Conceptual skills lag markedly behind those of peers
(reading, writing, math, etc.)
What characterizes the social domain of adaptive functioning deficits?
- Difficulty developing age-mates, is immature in social interac tions
- Difficulty accurately perceiving peers’ social cues
- Communication, conversation, language are less mature
- Difficulties regulating emotion and behavior (noticed by peers)
- Social judgment immature and person is at risk of being manipulated by others
What characterizes the practical domain of adaptive functioning deficits?
Difficulty with age-appropriate personal care
Difficulty with complex daily living tasks in comparison to peers
Generally need support to make health care decisions and legal decisions
Types of communication disorders
- Language disorder
- Speech sound disorder
- Social (pragmatic) communication disorder
- Childhood-onset fluency disorder (stuttering)
Assessments of speech, language and communication abilities must take what into account?
The individual’s cultural and language context
Language disorder is characterized by what?
Persistent difficulties in the acquisition and use of language across modalities, due to deficits in comprehension or production that includes:
Reduced vocab
Limited sentence structure
Impairments in discourse
Speech sound disorder is characterized by what?
Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages –> limitations in effective communication
Childhood-onset fluency disorder is characterized by what?
Disturbances in the normal fluency and time patterning of speech; the disturbance causes anxiety about speaking or limitations in effective communication, social participation, academic or occupational performance
Dysfluency is associated with what?
Neurological insult (stroke, tumor, trauma)
or
Another medical condition not better explained by another mental disorder
Social (pragmatic) communication disorder is characterized by what?
Persistent difficulties in the social use of verbal and nonverbal communication
(i.e. not knowing how to speak outside vs in a library, making inferences, difficulty understanding nonliteral or ambiguous meanings of language)
What is the most common associated feature of social (pragmatic) communication disorder?
Delay in reaching language milestones
Autism spectrum disorder is characterized by what?
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following:
- deficits in social-emotional reciprocity
- deficits in nonverbal communication behaviors
- Deficits in developing, maintaining, and understanding relationships
What are the possible etiologies associated with autism spectrum disorder?
Older paternal age
Maternal exposure to valproic acid during pregnancy
Genetics
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment is associated with what neurodevelopmental disorder?
Autism spectrum disorder
Autism spectrum disorder often co-occurs with what other disorder?
Intellectual disability disorder
What must be present to make a co-morbid diagnosis of autism spectrum disorder and intellectual disability?
Social communication should be below that expected for that general developmental level
What is the criteria for autism specturm disorder to be labeled a level 3?
Requires very substantial support
What is the criteria for autism specturm disorder to be labeled a level 2?
Requires substantial support
What is the criteria for autism specturm disorder to be labeled a level 1?
Requires support
Even when formal language skills are intact, what is impaired in autism spectrum disorder?
Use of language for reciprocal social communication
What is the most consistently useful behavioral intervention for autism spectrum disorder?
Education and support
Medications currently FDA approved for irritability and agitation associated with autism
Risperidone
Aripiprazole
Females with ADHD present more commonly with what subtype than do males?
Inattentive
Less disruptive behavior in females with ADHD may contribute to what?
Referral bias causing under identification and lack of treatment for females with ADHD
What percentage of children aged 8-15 met the DSM-5 criteria for any type of ADHD?
- 7%
(approx. 2.4 million)
What is the estimated prevalence of clinician-assessed adult ADHD?
4.4%
What comorbidities are associated with adult ADHD?
Mood disorders
Anxiety disorders
Substance use disorders
Intermittent explosive disorder
What comprises tourette’s syndrome triad?
Childhood onset of multiple motor and vocal tics lasting more than 1 year + ADHD + OCS
Note: OCS = obsessive-compulsive symptoms
What are the features of executive functioning?
Ability to assess a situation
Prioritizing what is relevant vs. irrelevant
Filtering out extraneous information
Make a plan how to act
Execute the plan
Assess effect of action in a fluid manner
Those with ADHD have altered executive functioning, in which there is an information processing dysfunction in the prefrontal cortex due to what?
Deficiency in dopamine and norepinephrine
What region of the brain has been identified as dysfunctional in ADHD by cross-study and cross-modality data?
Dorsal anterior midcingulate cortex (daMCC)
What is the DSM-5 diagnostic criteria for the diagnosis of ADHD in children?
6 or more symptoms of the disorder
What is the DSM-5 diagnostic criteria for the diagnosis of ADHD in adults?
Must have at least 5 of the symptoms of the disorder
What is the first line treatment of ADHD in preschool-aged children (4-5 years)?
Evidence-based parent and/or teacher-administered behavior therapy
What is the second line treatment of ADHD in preschool-aged children (4-5 years)?
Methylphenidate
What is the first line treatment of ADHD in elementary-aged children (6-11 years)?
FDA approved medications for ADHD
and
Evidence-based behavior therapy
What is the first line treatment of ADHD in adolescents (12-18 years)?
FDA approved medications
(preferrably add behavioral therapy)
What medication is used in adults only to treat the symptoms of ADHD and is associated with serious dermatologic and psychiatric reactions?
Modafinil
What criteria must be met for the diagnosis of Tourette’s syndrome?
Multiple motor tics and one or more phonic tics must be present at some point, not necessarily concurrently
Tics must occur many times a day for > 1 year
Onset of tics must be before the age of 21
What are the antidopaminergic drugs that are FDA approved for the treatment of Tourette’s syndrome?
Haloperidol
Pimozide
Aripiprazole
What is a possible side effect associated with the drugs used to treat Tourette’s syndrome?
Tardive dyskinesia
What antipsychotics are used to treat Tourette’s syndrome?
Fluphenazine
Risperidone
What α-adrenergic agonists are used to treat Tourette’s syndrome?
Clonidine
Guanfacine
What anticonvulsants are used to treat Tourette’s syndrome?
Topiramate
Valproic acid
Gabapentin
Botulinum toxin injections may be used to treat what symptoms associated with Tourette’s syndrome?
Focal motor and phonic tics
